Results of transvenous embolization of intracranial dural arteriovenous fistula: a consecutive series of 136 patients with 142 fistulas

2021 ◽  
pp. 1-9
Author(s):  
Alexis Guédon ◽  
Jean-Pierre Saint-Maurice ◽  
Cédric Thépenier ◽  
Marc-Antoine Labeyrie ◽  
Vittorio Civelli ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Consecutive Series ◽  
Lateral Sinus ◽  
Transvenous Embolization ◽  
Imaging Data ◽  
Major Treatment ◽  
Related Mortality

OBJECTIVE Intracranial dural arteriovenous fistula (DAVF) is mainly treated with an endovascular approach. Two major treatment advances include transvenous embolization (TVE) with coils in 1989 and, more recently, transarterial embolization with Onyx. The aim of this study was to present a large monocentric series of patients with DAVF treated with TVE. This series reports more than 20 years of experience and describes the evolution of the medical management of these patients, as well as current indications for this treatment at the authors’ center. METHODS Consecutive patients treated for intracranial DAVFs with TVE from 1995 to 2018 were included. Clinical and imaging data were systematically collected. Univariate and multivariate analyses were performed to identify factors that were significantly associated with adverse clinical course or complications. RESULTS In this study of 136 patients with 142 DAVFs treated with TVE, the occlusion rate was 90%. The median length of follow-up was 11 months. The rate of permanent complications was 5.1%, and the procedure-related mortality rate was 1.5%. Procedure-related mortality was associated with extension of thrombosis that was observed early in our experience. The introduction of a postoperative anticoagulation regimen has drastically decreased the occurrence of this complication. Other minor complications included cochleovestibular syndrome after embolization of lateral sinus DAVF and oculomotor nerve damage after embolization of cavernous sinus DAVF. CONCLUSIONS TVE allows efficient occlusion of DAVF. It remains a valid option for DAVF located on a sinus that does not participate in normal venous drainage of the brain.

scholarly journals Transvenous Embolization for Dural Arteriovenous Shunt of the Cavernous Sinus

2007 ◽  
Vol 13 (4) ◽  
pp. 353-358 ◽  
Author(s):  
S. Kato ◽  
H. Ishihara ◽  
H. Nakayama ◽  
M. Fujii ◽  
H. Fujisawa ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Cavernous Sinus ◽  
Cranial Nerve ◽  
Dural Arteriovenous Fistula ◽  
Clinical Symptoms ◽  
Transarterial Embolization ◽  
Arteriovenous Shunt ◽  
Complete Disappearance ◽  
Transvenous Embolization ◽  
Arteriovenous Shunts

We describe the treatment and follow-up clinical symptoms and angiographic results in patients with dural arteriovenous fistula of the cavernous sinus treated by transvenous embolization (TVE). We have treated eight cases of dural arteriovenous fistula of the cavernous sinus by multi-staged TVE in two cases and TVE with sinus packing in six and three of six cases were treated with a combination of transarterial embolization. Multi-staged TVE was performed by occlusion from dangerous drainage veins to the cavernous sinus on several occasions. Angiographical results showed disappearance or reduction of the arteriovenous shunt in all cases. Six patients presented with ophthalmic symptoms and two had tinnitus. Six cases had complete disappearance of clinical symptoms after treatment. There was a deterioration of ocular movement in one patient treated by TVE with sinus packing. Multi-staged TVE was performed to reduce the coil volume for the packing of the cavernous sinus in two cases without cranial nerve palsy. Embolization, especially multi-staged TVE, was considered a good treatment to occlude arteriovenous shunts at the cavernous sinus without cranial nerve complications.

scholarly journals Transarterial Embolization of a Cervical Dural Arteriovenous Fistula

2006 ◽  
Vol 12 (4) ◽  
pp. 313-318 ◽  
Author(s):  
S.A. Ansari ◽  
J.P. Lassig ◽  
E. Nicol ◽  
B.G. Thompson ◽  
J.J. Gemmete ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Vertebral Artery ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Acute Onset ◽  
Drainage Patterns ◽  
The Right ◽  
Glue Embolization

We describe a case of a 75-year-old man who presented with acute onset of headache and subarachnoid hemorrhage and initial cerebral angiography was deemed “negative”. In retrospect, a faint contrast collection was present adjacent to the right vertebral artery at the C1 level suspicious for a small dural arteriovenous fistula (dAVF). Follow-up angiography with selective micro-catheter injections of the right vertebral artery and C1 radicular artery confirmed a complex dAVF with characteristically specific venous drainage patterns associated with a subarachnoid hemorrhage presentation. Subsequently, the cervical dAVF was treated with superselective glue embolization resulting in complete occlusion. Cervical dAVFs are extremely rare vascular causes of subarachnoid hemorrhage. Both diagnostic angiography and endovascular treatment of these lesions can be challenging, especially in an emergent setting, requiring selective evaluation of bilateral vertebral arteries and careful attention to their cervical segments. Although only a single prior case of a cervical dAVF presenting with subarachnoid hemorrhage has been successfully treated with embolization, modern selective transarterial techniques may allow easier detection and treatment of subtle pathologic arteriovenous connections.

scholarly journals Transvenous embolization for craniocervical junction epidural arteriovenous fistula with a pial feeder aneurysm

2019 ◽  
Vol 26 (2) ◽  
pp. 170-177
Author(s):  
Keisuke Yoshida ◽  
Shinsuke Sato ◽  
Tatsuya Inoue ◽  
Bikei Ryu ◽  
Shogo Shima ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Craniocervical Junction ◽  
Transvenous Embolization ◽  
Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Transvenous Approach

Arteriovenous fistulas at the craniocervical junction are rare vascular malformations with frequent hemorrhagic presentations, which may have a concurrent pial feeder aneurysm. A 65-year-old man presented with subarachnoid hemorrhage and angiography showed an epidural arteriovenous fistula at the C-2 level with an anterior spinal feeder aneurysm without perimedullary venous drainage. Transarterial coil embolization of the ruptured aneurysm and partial Onyx embolization of the shunt led to thrombosis of the aneurysm. However, three years later angiography showed an increased shunt flow and recurrence of the aneurysm. Transvenous embolization of the shunt using coils and Onyx yielded complete obliteration of the shunt, thus leading to occlusion of the aneurysm. This case demonstrates that partial transarterial embolization of arteriovenous fistula leaves a risk of rebleeding, whereas complete obliteration of the shunt with a transvenous approach can lead to disappearance of the flow-related aneurysm without embolization of the aneurysm itself.

Balloon-backstop technique: Preserving physiologic venous drainage during transvenous coil embolization of sigmoid sinus dural arteriovenous fistulas

2021 ◽  
pp. 197140092110428
Author(s):  
Madhavi Duvvuri ◽  
Michael T Caton ◽  
Kazim Narsinh ◽  
Matthew R Amans
Keyword(s):  
Arteriovenous Fistula ◽  
Coil Embolization ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Sigmoid Sinus ◽  
Transvenous Embolization ◽  
Venous Infarction ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Superior Petrosal Sinus

Dural arteriovenous fistulas can lead to catastrophic intracranial hemorrhage if left untreated. Transvenous embolization can cure arteriovenous fistulas, but preserving normal venous structures can be challenging. Inadvertent embolization of a functioning vein can result in catastrophic venous infarction or hemorrhage. Here, we report a case using balloon-assistance to facilitate preservation of the superior petrosal sinus during transvenous embolization of a sigmoid sinus dural arteriovenous fistula.

scholarly journals Utility of targeted balloon protection of the venous sinus for endovascular treatment of dural arteriovenous fistula by transarterial embolization with Onyx: A case report and literature review

2021 ◽  
Vol 12 ◽  
pp. 340
Author(s):  
Masahiko Tagawa ◽  
Akihiro Inoue ◽  
Kentaro Murayama ◽  
Shirabe Matsumoto ◽  
Saya Ozaki ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Successful Treatment ◽  
Dural Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Venous Sinus ◽  
Occipital Artery ◽  
Balloon Protection ◽  
Sinus Flow

Background: Onyx has already been reported as an effective and safe agent in transarterial embolization of cranial dural arteriovenous fistula (d-AVF). However, successful treatment is related to not only complete shunt obliteration but also preservation of a normal route of venous drainage. Here, we present a case of transverse sigmoid d-AVF in which successful treatment was achieved by transarterial Onyx embolization with targeted balloon protection of the venous drainage. Case Description: A 70-year-old man presented with a 3-month history of tinnitus in the left ear and mild headache. Magnetic resonance imaging (MRI) showed a cluster of abnormal blood vessels in the area of the left transverse sinus (TS)-sigmoid sinus (SS) junction. Cerebral angiography demonstrated a Cognard type IIa d-AVF at the left TS-SS junction, supplied mainly by vessels such as the left middle meningeal artery, left occipital artery, and left meningohypophyseal trunk. In the venous phase, the ipsilateral TS-SS was recognized as a functional sinus and the left vein of Labbe drained into the TS near the drainage channel. Based on these findings, we decided to perform endovascular treatment under a transarterial approach with Onyx using targeted balloon protection of the venous sinus to protect against Onyx migration and preserve antegrade sinus flow. The patient recovered well without sequelae, and follow-up MRI 12 months later showed complete disappearance of the d-AVF. Conclusion: This treatment strategy using targeted balloon protection may be very useful to preserve antegrade sinus flow in patients with Cognard type IIa d-AVF.

scholarly journals Unilateral contrast-enhancing pontomedullary lesion due to an intracranial dural arteriovenous fistula with perimedullary spinal venous drainage: the exception that proves the rule

2015 ◽  
Vol 123 (6) ◽  
pp. 1534-1539 ◽  
Author(s):  
Roland Roelz ◽  
Vera Van Velthoven ◽  
Peter Reinacher ◽  
Volker Arnd Coenen ◽  
Irina Mader ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Clinical Symptoms ◽  
Imaging Finding ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Mri Findings ◽  
Brainstem Lesion ◽  
Contrast Enhanced ◽  
Type V

A large spectrum of possible diagnoses must be taken into consideration when a contrast-enhancing lesion of the pontomedullary region is found on MRI. Among these diagnoses are neoplastic, inflammatory, and infectious, as well as vascular pathologies. The authors report a rare case of an intracranial dural arteriovenous fistula (DAVF) with perimedullary spinal venous drainage (Cognard Type V) that initially presented as a unilateral contrast-enhancing pontomedullary lesion mimicking a brainstem neoplasm in a 76-year-old man. Following occlusion of the DAVF by transarterial embolization that resulted in clinical and radiological improvement, the fistula recurred 10 months later and was finally cured by a combined endovascularand surgical approach that resulted in complete occlusion. Clinical symptoms and MRI findings gradually improved following this treatment. A literature review on the MRI findings of Cognard Type V DAVF was performed. Centrally located medullary or pontomedullary edema represents the typical imaging finding, while unilateral edema as seen in the authors’ patient is exceptionally rare. The hallmark imaging finding suggestive of DAVF consisting of perimedullary engorged vessels may not always be present or may only be very subtly visible. Therefore, the authors suggest performing contrast-enhanced MR angiography or even digital subtraction angiography in the presence of an unclear edematous brainstem lesion before scheduling stereotactic biopsy.

Transvenous Embolization in Patients with Dural Arteriovenous Fistula

2005 ◽  
Vol 53 (4) ◽  
pp. 245
Author(s):  
Eun Ju Lee ◽  
Woong Yoon ◽  
Jeong Jin Seo ◽  
Sang Soo Shin ◽  
Hyo Soon Lim ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Transvenous Embolization

scholarly journals Transnasal flow reduction in endovascular treatment for anterior cranial fossa dural arteriovenous fistula

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Shuhei Kawabata ◽  
Hajime Nakamura ◽  
Takeo Nishida ◽  
Masatoshi Takagaki ◽  
Nobuyuki Izutsu ◽  
...  
Keyword(s):  
Blood Flow ◽  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Anterior Cranial Fossa ◽  
Maxillary Artery ◽  
Flow Reduction ◽  
Cranial Fossa ◽  
Embolic Materials

ABSTRACT Transarterial embolization (TAE) is a useful option for anterior cranial fossa–dural arteriovenous fistula (ACF–dAVF) as endovascular devices have progressed. Liquid agents are usually injected via a microcatheter positioned just proximal to the shunt pouch beyond the ophthalmic artery; however, high blood flow from the internal maxillary artery (IMA) often impedes penetration of embolic materials into the shunt pouch. Therefore, reducing blood flow from the IMA before embolization can increase the success rate. In the present case, to reduce blood flow from branches of the IMA, we inserted surgical gauze infiltrated with xylocaine and epinephrine into bilateral nasal cavities. Using this method, we achieved curative TAE with minimal damage to the nasal mucosa. Transnasal flow reduction is an easy, effective and minimally invasive method. This method should be considered in the endovascular treatment of ACF–dAVF, especially in patients with high blood flow from theIMA.

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