Complication rate, cure rate, and long-term outcomes of microsurgery for intracranial dural arteriovenous fistulae: a multicenter series and systematic review

Sugiyama, Taku; Nakayama, Naoki; Ushikoshi, Satoshi; Kazumata, Ken; Okamoto, Michinari; Ito, Masaki; Osanai, Toshiya; Shimoda, Yusuke; Uchida, Kei; Shimbo, Daisuke; Ito, Yasuhiro; Asaoka, Katsuyuki; Nakamura, Toshitaka; Kuroda, Satoshi; Houkin, Kiyohiro

doi:10.1007/s10143-019-01232-y

Cited by 24 publications

(20 citation statements)

References 42 publications

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“…In general, the symptoms of DAVFs are divided into hemorrhagic and nonhemorrhagic types (10). In our study of 104 DAVFs, 46.2% of patients had hemorrhagic symptoms at onset.…”

Section: Discussionmentioning

confidence: 63%

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Is the Middle Meningeal Artery the Optimal Path for Dural Arteriovenous Fistula Embolization?

Wang

et al. 2021

Front. Neurol.

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Background: The middle meningeal artery (MMA) is the optimal arterial path for endovascular treatment (EVT) of dural arteriovenous fistulas (DAVFs). However, the details are not completely understood.Materials and Methods: We performed a retrospective study of patients who were admitted to the First Hospital of Jilin University with a diagnosis of cranial DAVF with involvement of the MMA as a feeding artery. On the basis of the arterial path chosen and the role of the MMA in the first EVT procedure, EVT was divided into three types (I–III), each of which was further divided into two subclasses (a and b). The degree of embolization was analyzed.Result: The 104 included patients ranged in age from 13 to 80 years (mean, 53.6 ± 11.8 years). There were 48 cases of hemorrhage (46.2%, 48/104). Complete embolization was achieved in the first procedure in 64.4% of cases, and success was eventually achieved using EVT (the first attempt or a subsequent attempt) in 74.1% of cases. EVT caused complications in 6.7% of cases. A modified Rankin scale score of 0 or 1 was achieved in 78.8% of patients. Statistical analyses revealed that type Ia and IIb EVTs had the lowest complete embolization rates, but no difference was found between type Ia and IIb EVTs. Types IIa and III EVT had the highest complete embolization rates. Most cases had a good prognosis.Conclusion: These findings elucidate the features of the different EVT classes defined by the first EVT procedure and the role of the MMA. The delivery of treatment via slim and tortuous MMA branches increased the failure rate of EVT. A thick, straight MMA branch is the optimal path for treatment.

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“…In general, the symptoms of DAVFs are divided into hemorrhagic and nonhemorrhagic types (10). In our study of 104 DAVFs, 46.2% of patients had hemorrhagic symptoms at onset.…”

Section: Discussionmentioning

confidence: 63%

“…The reason for this finding is that the branches of the MMA easily reach these locations, which tend to exhibit DAVFs. For cranial DAVFs, the MMA is the most common source as the feeding artery (10). Certainly, other arteries may be involved, including the OA, PMA, and MHT, which occurred at rates of 47.1, 29.8, and 26.0%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Is the Middle Meningeal Artery the Optimal Path for Dural Arteriovenous Fistula Embolization?

Wang

et al. 2021

Front. Neurol.

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“…As incomplete obliteration of the dAVFs can cause recurrence, complete occlusion of the shunt points is needed to obtain favorable outcomes. [ 2 , 8 , 17 , 20 ] Recently, a surgical hybrid operating room (OR) equipped with an angiographic system has become a useful tool for the surgical treatment of vascular diseases because it can accommodate both endovascular embolization and microsurgery simultaneously. [ 4 , 5 , 12 ] To achieve complete occlusion of the AVFs, we developed a combined surgical technique of endovascular embolization and direct surgery in the hybrid OR.…”

Section: Introductionmentioning

confidence: 99%

“…[ 4 , 5 , 12 ] To achieve complete occlusion of the AVFs, we developed a combined surgical technique of endovascular embolization and direct surgery in the hybrid OR. [ 2 , 3 , 9 , 19 , 20 ] In this case series, we reviewed the clinical outcomes of refractory AVF patients who underwent procedures combining endovascular embolization and direct surgical approach and evaluated the outcome of this method.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of procedures combining endovascular embolization with a direct surgical approach in a hybrid operating room for the treatment of refractory dural arteriovenous fistulas

Kato

Ishibashi

Maruyama

et al. 2021

Surgical Neurology International

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Background: We reviewed the clinical outcomes of a procedure that combines endovascular embolization and a direct surgical approach in a hybrid operating room (OR) for the treatment of refractory dural arteriovenous fistulas (dAVFs). Methods: All patients with intracranial dAVFs who underwent a procedure combining endovascular embolization and direct surgical approach with biplane angiography or a robotic C-arm system in a hybrid OR between February 2004 and June 2020 were considered. Borden grading, occlusion rate, pre-and post-operative modified Rankin Scale (mRS) scores, and complications were retrospectively investigated. The pre-and postoperative mRS scores were compared using the Wilcoxon signed-ranks test. Results: We evaluated 14 arteriovenous fistulas (AVFs) in consecutive 13 patients. Of these, ten AVFs were previously treated with endovascular embolization, ten were located in the transverse-sigmoid sinus, and four in the cortical vein. The Borden grade was II in two AVFs and III in 12 AVFs. Immediate occlusion of the AVF was achieved in 13 AVFs, and gradual occlusion was observed in one case. The median preoperative mRS was 1 (0–3), whereas the median postoperative mRS was 0 (0–1) which indicated marked improvement (P = 0.006). Complications including postoperative transient visual disturbance and intraprocedural extravasation were observed in only two cases. Conclusion: The combination of endovascular embolization and direct surgical approach in a hybrid OR could achieve sufficient occlusion of refractory AVFs with acceptable complication rates and improved symptoms.

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“…Em três casos ocorreram déficits neurológicos transitórios (paralisia de nervo craniano ou hemiparesia) e um paciente evoluiu com hemiparesia permanente. Houve um óbito, decorrente de volumoso edema cerebral intraoperatório Sugiyama et al (2020). publicaram uma série de 39 pacientes portadores de FAVDs que foram submetidos a tratamento microcirúrgico.…”

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Tratamento endovascular de fístulas arteriovenosas durais tentoriais: uso da via arterial como estratégia de primeira linha

Rezende¹

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meu orientador. Ao longo das últimas décadas exerceu com excelência a atividade assistencial e o ensino, além de fomentar incessantemente a pesquisa. Tornou-se o maior neurorradiologista intervencionista do Brasil. Ao me receber como aluno, propiciou-me avançar em minha carreira acadêmica. Ao colega Alexandre Cordeiro Ulhôa, meu primeiro mestre e estimado amigo. Pioneiro da Neurorradiologia Intervencionista mineira, possibilitou o despertar do meu interesse pela área. Ao meu colega e amigo, Felipe Padovani Trivelato. Sua ajuda na construção do projeto foi muito importante. Aos colaboradores do estudo, Luís Henrique Castro Afonso e Caio Molina. A Ludmila, por seu carinho e compreensão. Aos meus irmãos, Ary César e Lydice. A todos que direta ou indiretamente contribuíram no tratamento dos pacientes e na realização deste trabalho. Agradeço a Coordenação de Aperfeiçoamento de Pessoal de Nível Superior -Brasil (CAPES), pelo apoio prestado nas atividades e no desenvolvimento desse estudo de doutorado. RESUMO REZENDE, Marco Túlio Salles. Tratamento endovascular de fístulas arteriovenosas durais tentoriais: uso da via arterial como estratégia de primeira linha. 2021. 184 f. Tese (Doutorado

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Complication rate, cure rate, and long-term outcomes of microsurgery for intracranial dural arteriovenous fistulae: a multicenter series and systematic review

Cited by 24 publications

References 42 publications

Is the Middle Meningeal Artery the Optimal Path for Dural Arteriovenous Fistula Embolization?

Is the Middle Meningeal Artery the Optimal Path for Dural Arteriovenous Fistula Embolization?

Clinical outcomes of procedures combining endovascular embolization with a direct surgical approach in a hybrid operating room for the treatment of refractory dural arteriovenous fistulas

Tratamento endovascular de fístulas arteriovenosas durais tentoriais: uso da via arterial como estratégia de primeira linha

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