Changing Clinical and Therapeutic Trends in Tentorial Dural Arteriovenous Fistulas: A Systematic Review

Cannizzaro, Delia; Brinjikji, Waleed; Rammos, Stylianos K.; Murad, M. Hassan; Lanzino, Giuseppe

doi:10.3174/ajnr.a4394

Cited by 29 publications

(27 citation statements)

References 43 publications

(18 reference statements)

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“…Favorable results have been reported by TAE using Onyx for TdAVF. 5,6) For curative treatment by TAE, it is necessary to deliver Onyx to the affected vein, including the fistula point. For this purpose, the appropriate selection of the target vessel and injection of Onyx with the pressure occlusion of the bilateral OAs, and removing the balloons, confirmatory imaging was performed.…”

Section: Discussionmentioning

confidence: 99%

A Case of Curative Onyx Embolization for Tentorial dAVF via Low-flow Feeders with Temporary Balloon Occlusion of High-flow Feeders

Ogura

Hasegawa

Kumagai

et al. 2020

JNET

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Objective: For curative Onyx embolization of dural arteriovenous fistulas (dAVF) with multiple feeders, it is essential to select the optimal target artery as well as to control the blood flow at the fistula point. We report a case of tentorial dAVF (TdAVF) treated by Onyx embolization under flow control using balloon catheters. Case Presentation: A 66-year-old male was admitted to our hospital for treatment of TdAVF detected incidentally by MRI, which revealed a dilated and tortuous vein around the cerebellum. Cerebral angiography demonstrated a TdAVF, fed mainly by bilateral middle meningeal arteries (MMA) and bilateral occipital arteries (OA), with the fistula point at the torcular and venous drainage to the two superior vermian veins (SVVs). Onyx 18 was injected from the low-flow feeder of the MMA under flow control by occluding the high-flow feeder of the OA using balloon catheters, obliterating the arteriovenous shunt. Conclusion: In treatment of TdAVF involving low-and high-flow feeders, Onyx embolization via the low-flow feeder with temporary balloon occlusion of other high-flow feeders is a useful method. This technique makes it easier for Onyx to penetrate the fistula point. Keywords▶ tentorial dural arteriovenous fistula, torcular, Onyx, balloon catheter, DeFrictor This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.

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Section: Discussionmentioning

confidence: 99%

A Case of Curative Onyx Embolization for Tentorial dAVF via Low-flow Feeders with Temporary Balloon Occlusion of High-flow Feeders

Ogura

Hasegawa

Kumagai

et al. 2020

JNET

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“…Tentorial dAVFs are often difficult to treat curatively by endovascular means, 3 and in these cases may require open surgery. The transsylvian approach has been described for accessing dAVFs of the anterior tentorium/ sphenoid ridge.…”

Section: Tentorial Region Davfsmentioning

confidence: 99%

The oculomotor-tentorial triangle. Part 2: a microsurgical workspace for vascular lesions in the crural and ambient cisterns

Gandhi¹,

Meybodi²,

Lawton³

2019

Journal of Neurosurgery

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OBJECTIVE Pathology in the region of the basilar quadrifurcation, anterolateral midbrain, medial tentorium, and interpeduncular and ambient cisterns may be accessed anteriorly via an orbitozygomatic (OZ) craniotomy. In Part 1 of this series, the authors explored the anatomy of the oculomotor-tentorial triangle (OTT). In Part 2, the versatility of the OTT as a surgical workspace for treating vascular pathology is demonstrated. METHODS Sixty patients with 61 vascular pathologies treated within or via the OTT from 1998 to 2017 by the senior author were retrospectively reviewed. Patients were grouped together based on pathology/surgical procedure and included 1) aneurysms (n = 19); 2) posterior cerebral artery (PCA)/superior cerebellar artery (SCA) bypasses (n = 24); 3) brainstem cavernous malformations (CMs; n = 14); and 4) tentorial region dural arteriovenous fistulas (dAVFs; n = 4). The majority of patients were approached via an OZ craniotomy, wide sylvian fissure split, and temporal lobe mobilization to widen the OTT. RESULTS Aneurysm locations included the P-P junction (n = 7), P segment (n = 9), P (n = 2), and basilar quadrification (n = 1). Aneurysm treatments included clip reconstruction (n = 12), wrapping (n = 3), proximal occlusion (n = 2), and trapping with (n = 1) or without (n = 1) bypass. Pathologies in the bypass group included vertebrobasilar insufficiency (VBI; n = 3) and aneurysms of the basilar trunk (n = 13), basilar apex (n = 4), P PCA (n = 2), and s SCA (n = 2). Bypasses included M middle cerebral artery (MCA)-radial artery graft (RAG)-P PCA (n = 8), M MCA-saphenous vein graft (SVG)-P PCA (n = 3), superficial temporal artery (STA)-P PCA (n = 5) or STA-s SCA (n = 3), s SCA-P PCA (n = 1), V vertebral artery (VA)-RAG-s SCA (n = 1), V VA-SVG-P PCA (n = 1), anterior temporal artery-s SCA (n = 1), and external carotid artery (ECA)-SVG-s SCA (n = 1). CMs were located in the midbrain (n = 10) or pontomesencephalic junction (n = 4). dAVFs drained into the tentorial, superior petrosal, cavernous, and sphenobasal sinuses. High rates of aneurysm occlusion (79%), bypass patency (100%), complete CM resection (86%), and dAVF obliteration (100%) were obtained. The overall rate of permanent oculomotor nerve palsy was 8.3%. The majority of patients in the aneurysm (94%), CM (93%), and dAVF (100%) groups had stable or improved modified Rankin Scale scores. CONCLUSIONS The OTT is an important anatomical triangle and surgical workspace for vascular lesions in and around the crural and ambient cisterns. The OTT can be used to approach a wide variety of vascular pathologies in the region of the basilar quadrifurcation and anterolateral midbrain.

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“…3,4 Therefore, surgical or endovascular intervention is recommended even for asymptomatic tentorial DAVFs. 2,[4][5][6][7] With recent advances in endovascular technology, patients with tentorial DAVFs are increasingly treated endovascularly with a high rate of good neurologic outcomes. 5,8 Onyx (Medtronic Co., Dublin, Ireland) is a liquid embolic agent that offers increased controllability and deep fistula penetration due to its lower viscosity and delayed precipitation compared with other embolic agents.…”

Section: Introductionmentioning

confidence: 99%

A hemorrhagic complication after Onyx embolization of a tentorial dural arteriovenous fistula: A caution about subdural extension with pial arterial supply

et al. 2017

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We report a case of tentorial dural arteriovenous fistula (DAVF) with a severe intracranial hemorrhage occurring after Onyx embolization. A 40-year-old man presented with an asymptomatic tentorial DAVF on angiography. Transarterial embolization with Onyx was performed via the middle meningeal artery, and the cast filled the fistula itself and its proximal draining vein. Postoperative angiography confirmed complete occlusion of the DAVF. A computed tomography scan performed immediately after the procedure demonstrated an acute subdural hematoma with the temporal hemorrhage. Emergency craniotomy revealed continuous arterial bleeding from a viable glomus-like vascular structure around the proximal part of the embolized draining vein, fed by a pial artery arising from the posterior cerebral artery. Pathologic findings suggested diagnosis of vascular malformation extending into the subdural space. Tentorial DAVFs can extend to the subdural space along their drainage route, and may be involved in severe hemorrhagic complications of curative endovascular treatment using Onyx, particularly those with pial arterial supply.

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Changing Clinical and Therapeutic Trends in Tentorial Dural Arteriovenous Fistulas: A Systematic Review

Cited by 29 publications

References 43 publications

A Case of Curative Onyx Embolization for Tentorial dAVF via Low-flow Feeders with Temporary Balloon Occlusion of High-flow Feeders

A Case of Curative Onyx Embolization for Tentorial dAVF via Low-flow Feeders with Temporary Balloon Occlusion of High-flow Feeders

The oculomotor-tentorial triangle. Part 2: a microsurgical workspace for vascular lesions in the crural and ambient cisterns

A hemorrhagic complication after Onyx embolization of a tentorial dural arteriovenous fistula: A caution about subdural extension with pial arterial supply

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