Resolution of Trigeminal Neuralgia After Surgical Disconnection of a Foramen Magnum Dural Arteriovenous Fistula

Chen, Hao; Chen, Rudong; Yang, Haitao; Li, Hua; Wang, Junhong; Yu, Jing

doi:10.1016/j.wneu.2019.07.063

Cited by 7 publications

(2 citation statements)

References 53 publications

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“…Microsurgery has also been useful in cases with symptoms caused by the mass effect of the dilated venous pouch and the shunt fistula ( 1 ). Chen et al reported that trigeminal neuralgia due to a foramen magnum DAVF compression was completely relieved after surgical disconnection ( 9 ). In addition, although seldom reported, surgery-related complications (intracranial hematoma, intracranial infection, etc.,) cannot be completely avoided.…”

Section: Discussionmentioning

confidence: 99%

“…However, in the past decade, with remarkable advances in the endovascular techniques providing highly flexible hydrophilic-coated catheters and new non-adhesive liquid embolic agents, such as Onyx and N-butyl-cyanoacrylate (NBCA) glue, endovascular embolization of the fistula has become an alternative option for treating the foramen magnum DAVFs ( 6 – 8 ). It has been reported that ~80% of the foramen magnum DAVFs in the literature were treated endovascularly ( 9 ). Nevertheless, the incomplete obliteration and reoccurrence of the fistula after endovascular embolization could not be underestimated, and some cases even required staged or salvage combined surgeries ( 1 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

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Clinical features, angio-architectural phenotypes, and treatment strategy of foramen magnum dural arteriovenous fistulas: a retrospective case series study

et al. 2023

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BackgroundThe rarity and complex angioarchitecture of foramen magnum dural arteriovenous fistulas (DAVFs) make its treatment difficult and controversial. We aimed to describe their clinical features, angio-architectural phenotypes, and treatments, through a case series study.MethodsWe first retrospectively studied cases of foramen magnum DAVFs treated in our Cerebrovascular Center, and then reviewed the published cases on Pubmed. The clinical characteristics, angioarchitecture, and treatments were analyzed.ResultsA total of 55 patients were confirmed with foramen magnum DAVFs, which included 50 men and 5 women, with a mean age of 52.8 years. Most patients presented with subarachnoid hemorrhage (SAH) (21/55) or myelopathy (30/55), depending on the venous drainage pattern. In this group, 21 DAVFs were supplied by only the vertebral artery (VA), three by only the occipital artery (OA), three by only the ascending pharyngeal artery (APA), and the remaining 28 DAVFs were supplied by two or three of these feeding arteries. Most cases (30/55) were treated with only endovascular embolization, 18 cases (18/55) with only surgical disconnection, five cases (5/55) with combined therapy, and two cases rejected treatment. The angiographic outcome of complete obliteration was achieved in most patients (50/55). In addition, two cases of foramen magnum DAVFs were treated by us in a Hybrid Angio-Surgical Suite (HASS) with good outcomes.ConclusionsForamen magnum DAVFs are rare and their angio-architectural features are complicated. The treatment option (microsurgical disconnection or endovascular embolization) should be weighed carefully, and combined therapy in HASS could be a more feasible and less invasive treatment option.

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Section: Discussionmentioning

confidence: 99%