Dural Arteriovenous Fistulas*

Neumaier-Probst, Eva

doi:10.1007/s00062-009-8038-8

Cited by 8 publications

(3 citation statements)

References 47 publications

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“…Concerning well-established TVE procedures, there are several endovascular techniques, reported in the current literature:[ 21 ] (1) Transvenous occlusion of the sinus;[ 3 ] (2) Transvenous occlusion of the venous pouch outside the sinus;[ 22 ] According to Neumaier-Probst’s review of DAVFs,[ 21 ] TVE is not suitable for lesions with antegrade venous drainage into the relevant dural sinus or normal brain venous drainage through the sinus (Cognard I, IIa, and III). Indications for TVE include (1) dAVF supply by small tortuous arteries excluding safe transarterial access to fistulous part, (2) dAVF exclusively supplied by branches directly from the ICA or vertebral artery, (3) dAVF supplied by arteries with dangerous extracranial to the intracranial anastomosis, and (4) dAVF supplied by nutrient arteries of cranial nerves.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided transjugular embolization of ruptured huge venous ectasia of a Cognard IV tentorial dural arteriovenous fistula as a first-stage lifesaving procedure: Review of the literature

et al. 2021

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Tentorium is a rare location of the brain dural arteriovenous fistulae (DAVF) consisting <4% of cases. Hemorrhagic clinical presentation is common, as cortical venous reflux consists a usual characteristic of tentorial DAVF’s angioarchitecture. We present a case of transvenous, transjugular embolization of a ruptured huge venous ectasia of a Cognard IV tentorial middle-line DAVF, as a first step life-saving procedure. Initially, a transarterial antegrade embolization attempt was performed but failed due to the tortuous course of arterial feeders. Subsequently, the internal jugular vein (IJV) was directly catheterized under ultrasound (U/S) guidance and a 6F guiding catheter was placed at the ipsilateral transverse sinus. A microcatheter was navigated inside the venous ectasia and eventually, coils were deployed inside causing complete occlusion of the huge venous ectatic aneurysm. In this way, initial occlusion of the venous ectatic ruptured point has been achieved as a first-stage lifesaving treatment. Subsequently, the patient underwent stereotactic radiosurgery for the DAVF 4 months after embolization. Angiographic control with digital subtraction angiography 2 years after embolization and additional stereotactic radiosurgery revealed complete occlusion of the tentorial DAVF. The patient experienced complete neurological recovery. Direct puncture of the IJV under U/S guidance may assist transvenous embolization of ruptured venous ectasia in case of complex tentorial middle-line DAVFs type IV when the ecstatic venous aneurysm is recognized as the bleeding source.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-guided transjugular embolization of ruptured huge venous ectasia of a Cognard IV tentorial dural arteriovenous fistula as a first-stage lifesaving procedure: Review of the literature

et al. 2021

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“…But these complications are partly dependent on the endovascular procedure. 4,11 With respect to both complete occlusion and to reduced complications, the venous approach could be advantageous.…”

Section: Discussionmentioning

confidence: 99%

Complete Endovascular Occlusion of a Cranial Dural Fistula using a Venous “To the Point” Approach

Gizewski

Göricke

Özkan

et al. 2012

J Neurol Surg A Cent Eur Neurosurg

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“…Die Ätiologie von Durafisteln ist weiterhin unklar und wird kontrovers diskutiert. Gemäß Neumaier-Probst et al werden vor allem venöse Obstruktionen mit daraus resultierender Erhöhung des venösen oder arteriellen Druckes und Erweiterung vorbestehender arteriovenöser Mikro-Shunts in der Dura als Ursache diskutiert [1,2]. Weiterhin werden postthrombotische Vorgänge infolge Rekanalisierung einer Sinusthrombose angenommen [2 -5].…”

Section: Fallberichteunclassified

Die Durafistel – ein unscheinbares morphologisches Korrelat mit großen Konsequenzen

Kuerten¹,

Sparing²,

Rottlaender³

et al. 2009

Fortschr Neurol Psychiatr

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Dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous shunts located within the dura mater representing approximately 10 - 15 % of all arteriovenous shunts in the central nervous system. The aetiology of spontaneous DAVFs remains to be elucidated. The symptoms associated with DAVFs can be highly variable and dependent upon the direction of the blood flow, the amount of arteriovenous shunting and the specific location of the fistula. Considering the diversity of clinical presentation in the setting of unremarkable imaging results, diagnosing a DAVF can be difficult. To avoid permanent neurological deficits due to DAVFs, it is important to consider the possibility of a DAVF whenever one encounters unclear neurological symptoms and to initiate appropriate diagnostic procedures including intraarterial DSA and MRI/MRA. The current DAVF classification accounts for the disparity of clinical symptoms, therapeutic/interventional implications as well as vital complications depending on each particular fistula subtype. While type I DAVFs drain anterogradely into a cerebral sinus and mainly cause functional deficits, the risk for severe intracerebral bleeding increases when DAVFs drain retrogradely (type II), or into cortical (types III and IV), perimedullar or radiculo-medullar veins (type V), respectively. In particular in the case of type IIb to V DAVFs, the appropriate treatment option is a complete fistula occlusion by transvenous embolization, transarterial glue or particulate embolization or surgery. In the following we systematically explain the differential anatomy underlying DAVFs and discuss possible symptoms and necessary diagnostic and therapeutic means. In that, we are seeking to increase attention for this rare, but clinically relevant neurological disease.

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Dural Arteriovenous Fistulas*

Cited by 8 publications

References 47 publications

Ultrasound-guided transjugular embolization of ruptured huge venous ectasia of a Cognard IV tentorial dural arteriovenous fistula as a first-stage lifesaving procedure: Review of the literature

Ultrasound-guided transjugular embolization of ruptured huge venous ectasia of a Cognard IV tentorial dural arteriovenous fistula as a first-stage lifesaving procedure: Review of the literature

Complete Endovascular Occlusion of a Cranial Dural Fistula using a Venous “To the Point” Approach

Die Durafistel – ein unscheinbares morphologisches Korrelat mit großen Konsequenzen

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