A case of successful endovascular treatment of cavernous dural arteriovenous fistula using 3D-rotational angiography

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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Endovascular treatment of anterior cranial fossa dural arteriovenous fistula

Neuroradiology ◽

10.1007/s00234-007-0346-6 ◽

2008 ◽

Vol 50 (5) ◽

pp. 433-437 ◽

Cited By ~ 35

Author(s):

Xianli Lv ◽

Youxiang Li ◽

Zhongxue Wu

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Anterior Cranial Fossa ◽

Cranial Fossa

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The remnant of primary head sinus found in the case of dural arteriovenous fistula: A case report

Interventional Neuroradiology ◽

10.1177/1591019916641903 ◽

2016 ◽

Vol 22 (4) ◽

pp. 452-456 ◽

Cited By ~ 1

Author(s):

Katsuhiro Mizutani ◽

Takenori Akiyama ◽

Kazunari Yoshida

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Rare Condition ◽

Venous Drainage ◽

Petrous Bone ◽

Jugular Bulb ◽

Cone Beam ◽

Middle Fossa ◽

Rotational Angiography ◽

Anatomic Information

In the embryo, the primary head sinus (PHS) is the first venous drainage channel in the craniocervical region. During embryonic development, this channel regresses and usually disappears completely; accordingly, a remnant of the PHS is an extremely rare condition and has been described in only a few previous studies. Here, we report a case of remnant of the PHS with a dural arteriovenous fistula (dAVF) in an adult. The remnant of the PHS had penetrated the petrous bone to run from the middle fossa to the jugular bulb and served as a drain for the middle fossa dAVF. We used digital subtraction angiography and reconstructed cone-beam computed tomography in 3D rotational angiography to obtain detailed anatomic information about the remnant PHS and additionally scrutinised and discussed its features.

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Low-Dose 3D Rotational Angiography in Measuring the Size of Intracranial Aneurysm: In Vitro Feasibility Study Using Aneurysm Phantom

Neurointervention ◽

10.5469/neuroint.2020.00437 ◽

2021 ◽

Vol 16 (1) ◽

pp. 59-63

Author(s):

Hee Jong Ki ◽

Bum-soo Kim ◽

Jun-Ki Kim ◽

Jai Ho Choi ◽

Yong Sam Shin ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Endovascular Treatment ◽

Low Dose ◽

Three Dimensional ◽

3D Measurement ◽

Rotational Angiography ◽

3D Rotational Angiography ◽

Conventional Dose ◽

Noninferiority Margin

Purpose: Three-dimensional (3D) measurement of intracranial aneurysms is important in planning endovascular treatment, and 3D rotational angiography (RA) is effective in accurate measurement. The purpose of this study was to evaluate the feasibility of low dose 3D RA (5 seconds 0.10 μGy/frame) in measuring an intracranial aneurysm using an in vitro phantom.Materials and Methods: We investigated an <I>in vitro</i> 3D phantom of an intracranial aneurysm with 10 acquisitions of 3D RA with a conventional dose (5 seconds 0.36 μGy/frame) and 10 acquisitions with a low-dose (5 seconds 0.10 μGy/frame). 3D size and neck diameters of the aneurysm were measured and compared between the 2 groups (conventional and low-dose) using noninferiority statistics.Results: The aneurysm measurements were well-correlated between the 2 readers, and noninferiority in the measurement of aneurysmal size of low-dose 3D RA was demonstrated, as the upper margin of the 1-sided 97.5% confidence interval did not cross the pre-defined noninferiority margin of 0.2 mm by the 2 readers.Conclusion: Low-dose (5 seconds 0.10 μGy/frame) cerebral 3D RA is technically feasible and not inferior in in vitro 3D measurement of an intracranial aneurysm. Thus, low-dose 3D RA is promising and needs further evaluation for its clinical utility in the planning of endovascular treatment of an intracranial aneurysm.

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Endovascular Treatment of an Intracranial Dural Arteriovenous Fistula with Spinal Venous Drainage

Interventional Neuroradiology ◽

10.1177/159101999800400308 ◽

1998 ◽

Vol 4 (3) ◽

pp. 241-246 ◽

Cited By ~ 1

Author(s):

R. Cruz ◽

A. Stocker ◽

J. Xavier ◽

J. Almeida-Pinto

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Clinical Presentation ◽

Venous Drainage ◽

Hyperintense Signal ◽

Type V ◽

Progressive Paraparesis ◽

T2 Weighted Images

A case of type V intracranial dural arteriovenous fistula (DAVF) is reported because of its unusual rapidly progressive paraparesis. Despite this clinical presentation, the diagnosis of DAVF was made and precocious endovascular treatment was instituted. Angiographic normalization was obtained after embolisation and the patient significantly improved within the first weeks, although at the six month control MRI there still was a hyperintense signal of the cord in T2 weighted images, but less extensive than originally.

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Dural Arteriovenous Fistula at the Anterior Condylar Confluence

Interventional Neuroradiology ◽

10.1177/159101990801400311 ◽

2008 ◽

Vol 14 (3) ◽

pp. 303-312 ◽

Cited By ~ 33

Author(s):

S. Miyachi ◽

T. Ohshima ◽

T. Izumi ◽

T. Kojima ◽

J Yoshida

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Three Dimensional ◽

Drainage Pattern ◽

Hypoglossal Canal ◽

Shunt Occlusion ◽

Meningeal Arteries ◽

Anterior Condylar Vein ◽

Angiographic Findings

We reviewed the records of eight patients with a dural arteriovenous fistula (DAVF) close to the hypoglossal canal and determined the angioarchitecture of the clinical entity at the anterior condylar confluence. Eight patients with DAVF received endovascular treatment at our institute over the past five years. Imaging with selective three-dimensional angiography and thin-slice computed tomography were used to identify the fistula and evaluate the drainage pattern. Based on the angiographic findings, the ascending pharyngeal artery was the main feeder in all cases, and the occipital, middle meningeal, posterior auricular, and posterior meningeal arteries also supplied the DAVF to varying degrees. Contralateral contribution was found in five patients. The main drainage route was the external vertebral plexus via the lateral condylar veins in four patients, the inferior petrosal sinus in three patients, and the internal jugular vein via the connecting emissary veins in one patient. Selective angiography identified the shunt point at the anterior condylar confluence close to the anterior condylar vein. Shunt occlusion with transvenous coil packing was performed in all cases; transarterial feeder embolization was also used in three patients. Two patients treated with tight packing of the anterior condylar vein developed temporary or prolonged hypoglossal palsy. Based on our results, the main confluence of the shunt is located at the anterior condylar confluence connecting the anterior condylar vein and multiple channels leading to the extracranial venous systems. To avoid postoperative nerve palsy, the side of the anterior condylar vein in the hypoglossal canal should not be densely packed with coils. Evaluating the angioarchitecture using the selective three-dimensional angiography and tomographic imaging greatly helps to determine the target and strategy of endovascular treatment for these DAVF.

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