Multimodality Treatment of Intracranial Dural Arteriovenous Fistulas in the Onyx Era: a Single Center Experience

Natarajan, Sabareesh K.; Ghodke, Basavaraj; Kim, Louis J.; Hallam, Danial K.; Britz, Gavin W.; Sekhar, Laligam N.

doi:10.1016/j.wneu.2010.01.009

Cited by 147 publications

(111 citation statements)

References 59 publications

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“…The decision of embolization, the route, and the embolizing material were chosen based on the angiographic findings (29). After transfemoral access and sheath placement, the patient was heparinized, with 3000 units intravenously and 1000 units per hour of intravenous heparin, to maintain an activated coagulation time of between 250 and 300 seconds (29).…”

Section: █ Resultsmentioning

confidence: 99%

“…A DMSO compatible microcatheter (Marathon or Echelon; Covidien) with a microwire (Mirage or Silverspeed; Covidien) was then advanced into the selective branches as close to the nidus as possible and allowing for an adequate distance for reflux of the embolic agent, and superselective angiography was performed on the target branch or branches for embolization (29,38). When there were multiple feeders, the feeder with maximum reflux distance from the skull base was chosen to decrease the chances of cranial nerve palsies (29). Embolization of the DAVF was then performed with ONYX-18 in the manner previously described (26-28).…”

Section: █ Resultsmentioning

confidence: 99%

“…The venous drainage of DVAF is the most important predictor of the clinical behavior. DAVFs with cortical venous reflux (CVR) exhibit a much higher incidence of hemorrhage With the advent of ONYX (Covidien, Irvine, CA), most intracranial DAVFs can be successfully managed with transarterial ONYX embolization via their supply from the external carotid artery (ECA) branches, which can be safely embolized (29).…”

Section: █ Introductionmentioning

confidence: 99%

“…patients, thereby justifying treatment in appropriately selected patients (29). Our patients belonged to the high-risk category (Borden types II or III) and required active intervention to prevent risk of hemorrhage.…”

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confidence: 99%

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Transarterial onyx embolization of intracranial dural arteriovenous fistulas in adult patients

Liu

Li²,

Sun³

et al. 2013

Turkish Neurosurgery

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Section: █ Resultsmentioning

confidence: 99%

Section: █ Resultsmentioning

confidence: 99%

Section: █ Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Transarterial onyx embolization of intracranial dural arteriovenous fistulas in adult patients

Liu

Li²,

Sun³

et al. 2013

Turkish Neurosurgery

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“…10,16,28 In the clinical study by Shi et al, 22 of 11 DAVFs involving the sphenoid region, 2 required microsurgical disconnection of cortical draining veins after incomplete endovascular embolization. While this type of staged approach is well documented, reports of simultaneous integrated open surgery and endovascular embolization of CCFs are rare in the literature.…”

Section: Discussionmentioning

confidence: 99%

Integrated open surgical and endovascular embolization treatment of a paracavernous venous plexus fistula: case report

Dye

Buchanan²,

Gonzalez³

2015

JNS

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case report J Neurosurg 122:933-938, 2015 P aracavernous venous plexus fistulas are rare types of dural arteriovenous fistulas (DAVFs) that can mimic indirect carotid-cavernous fistulas (CCFs) in both imaging characteristics and clinical presentation. While similar to CCFs, their anatomical differences lead to differences in management. Key differences include the distinct patterns of venous drainage, which affect the options for endovascular access, and the actual location of the abnormal shunt. Both types of fistula may have drainage through the superior ophthalmic vein, the plexus of the foramen ovale to the pterygoid plexus, and/or the deep middle cerebral vein. However, unlike a CCF, the paracavernous venous plexus fistula does not drain directly through the inferior petrosal sinus, but rather it drains through the cavernous sinus. Because the fistulous connection resides in the paracavernous venous plexus and not in the cavernous sinus, embolization of the cavernous sinus does not treat the fistula and can endanger the patient by altering the drainage toward cerebral veins (Fig. 1). This anatomical difference in location and venous drainage can make these types of DAVFs very difficult to treat by endovascular interventions alone.In this report the authors describe the presentation, imaging findings, and integrated open surgery and endovascular embolization of a rare type of DAVF, a paracavernous venous plexus fistula. case report History and ExaminationA 66-year-old right-handed Asian man presented with a 2-year history of persistent right eye chemosis. He was initially evaluated by an ophthalmologist who prescribed steroid eye drops, resulting in mild temporary improvement. However, the symptoms recurred and persisted. He reported right-sided occipital region headaches occurring approximately 3 times per week and mild right orbital proptosis. At presentation, he denied eye pain, recent change in his visual acuity, double vision, photophobia, nausea, and neck stiffness. On examination, he was found to have right eye chemosis, proptosis, and an orbital bruit. His right eye intraocular pressure was measured at 19 mm Hg. His visual fields were full to confrontation. Brain MRI/ MR angiography revealed mild right proptosis without obvious prominence of the right cavernous sinus or enlargement of the right superior ophthalmic vein. Cerebral angiography demonstrated an arteriovenous shunt of the right paracavernous venous plexus (Fig. 2). The fistula was fed by meningeal branches of a dilated inferolateral trunk, the right accessory meningeal artery, and the artery of the foramen rotundum. There was early filling of the left cavernous sinus across the intercavernous sinus. The venous drainage of the fistula was predominantly through the abbreviatioNs CCF = carotid-cavernous fistula; CTA = CT angiography; DAVF = dural arteriovenous fistula; ICA = internal carotid artery; LCS = laterocavernous sinus; LWSS = lesser wing of the sphenoid sinus; SMCV = superficial middle cerebral vein. The authors report the treatment ...

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Middle meningeal artery: Gateway for effective transarterial Onyx embolization of dural arteriovenous fistulas

Griessenauer

Salem

et al. 2016

Clinical Anatomy

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Curative transarterial embolization of noncavernous sinus dural arteriovenous fistulas (dAVFs) is challenging. We sought to evaluate the role of the middle meningeal artery (MMA) in endovascular treatment of these lesions. We performed a retrospective cohort study on patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVFs with contribution from the MMA at a major academic institution in the United States from January 2009 to January 2015. Twenty consecutive patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVF were identified. One patient was excluded as there was no MMA contribution to the dAVF. All of the remaining 19 patients (61.3 ± 13.8 years of age) underwent transarterial embolization through the MMA. Six patients (31.6%) presented with intraparenchymal or subarachnoid hemorrhage from the dAVF. The overall angiographic cure rate was 73.7% upon last follow up. In 71.4% of successfully treated patients transarterial embolization of the MMA alone was sufficient to achieve angiographic cure. When robust MMA supply was present, MMA embolization resulted in angiographic cure even after embolization of other arterial feeders had failed in 92.9% of patients. A robust contribution of the MMA to the fistula was the single most important predictor for successful embolization (P = 0.00129). We attribute our findings to the fairly straight, non-tortuous course of the MMA that facilitates microcatheter access, navigation, and Onyx penetration. Noncavernous sinus dAVF can be successfully embolized with transarterial Onyx through the MMA, as long as supply is robust. A transvenous approach is rarely necessary. Clin. Anat. 29:718-728, 2016. © 2016 Wiley Periodicals, Inc.

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Multimodality Treatment of Intracranial Dural Arteriovenous Fistulas in the Onyx Era: a Single Center Experience

Cited by 147 publications

References 59 publications

Transarterial onyx embolization of intracranial dural arteriovenous fistulas in adult patients

Transarterial onyx embolization of intracranial dural arteriovenous fistulas in adult patients

Integrated open surgical and endovascular embolization treatment of a paracavernous venous plexus fistula: case report

Middle meningeal artery: Gateway for effective transarterial Onyx embolization of dural arteriovenous fistulas

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