Current status of endovascular treatment for dural arteriovenous fistulae in the anterior cranial fossa: A systematic literature review

Abstract

Anterior cranial fossa (ACF) dural arteriovenous fistulae (DAVFs) are rare, and a systematic review of the literature is lacking. Such a review is necessary, however, so a systematic PubMed search of related studies was performed. Twenty-four studies were identified, reporting on 48 patients, of whom 39 had definite age and sex information and 33 (84.6%, 33/39) were male. The afflicted patients were between 37 and 80 years old (mean 55.6). Among the 48 patients, 28 (58.3%, 28/48) primarily presented with intracranial hemorrhage, 47 (97.9%, 47/48) had feeding arteries from the anterior ethmoidal artery (AEA) of the ophthalmic artery (OA), and 40 (83.3%, 40/48) had bilateral feeding arteries. All of the cases had high-grade Cognard classifications (III-IV). Among the 48 patients, 43 (89.6%, 43/48) had drainage into the superior sagittal sinus (SSS). In addition, 36 (75%, 36/48) patients were treated via transarterial embolization (TAE). Of these patients, 28 (77.8%, 28/36) were managed via the AEA of the OA. Another 12 (25%, 12/48) patients were treated via transvenous embolization (TVE), 11 of whom (91.7%, 11/12) were treated with the trans-SSS approach. Complete angiographic cure was achieved in 44 (91.7%, 44/48) patients, with 4 (8.3%, 4/48) patients suffering from postprocedural complications. All 48 patients had clear descriptions of follow-up outcomes, with 45 (93.8%, 45/48) patients having a good outcome. Thus, when treating ACF DAVFs, endovascular treatment (EVT) can completely obliterate the fistula point and correct the venous shunting. EVT is therefore an effective treatment for ACF DAVF. Although many complications can occur, this approach achieves good outcomes in most cases.

Angiographic study of the transdural collaterals at the anterior cranial fossa in patients with Moyamoya disease

“…TDC through the PEA must anastomose with the branches or the main trunk of ACA, which is more difficult to form. This scenario has some similarity with arteriovenous fistula in the anterior cranial fossa, of which the AEA is more commonly involved as the feeding artery than the PEA [25]. This might denote that PEA TDCs are uncommon and gradually form with the progression MMD.…”

A Case of Anterior Cranial Fossa Dural Arteriovenous Fistula with Transient Ocular Movement Disorder after Embolization

“…Recently, there have been case reports of transvenous embolization via drainage veins such as SSS. 5) In the present case, TAE was selected based on the patient's age, general condition, and his request.…”

“…There was no case with visual disturbance reported in the review. 5) Among embolic agents, Onyx is easier to handle than n-butyl-2-cyanoacrylate (NBCA); it can be infused in a large amount at one time and its permeability into the shunt is high. Therefore, the cure rate is high and the incidence of complications is low.…”

Spontaneous Subdural Hematoma and Behavioral Changes Due to a Dural Arteriovenous Fistula. A Case Report and Literature Review

“…On the other hand, dementia in patients with DAVF is frequent and has been described in various case reports and case series [31,32,33,34,35,36,37]. The principal factor for dementia in DAVF cases is the cortical venous drainage, which produces venous congestion and hypertension, leading to congestive encephalopathy.…”

“…Diffuse deep and subcortical white matter lesions [27,33,34,35,37] and SPECT hypoperfusion [32] are the imagenological features most commonly described. In a series of 40 DAVF patients, the development of dementia because of venous hypertensive encephalopathy was evaluated.…”