Surgical treatment of dural arteriovenous malformation in the region of the sigmoid sinus

Hugosson, R.; Bergström, K

doi:10.1136/jnnp.37.1.97

Cited by 71 publications

(13 citation statements)

References 6 publications

(6 reference statements)

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“…In parallel with early surgical attempts at arterial ligation, 15,17,22 the earliest transfemoral endovascular approaches were focused on occlusion of arterial feeders to dAVFs. 11 Kendall and Logue's 19 elegant depiction of venous hypertension and the mere need to "disconnect" the fistula in cases of spinal dAVFs helped revolutionize our understanding of this lesion class and is the mainstay of treatment approaches today.…”

Section: Evolution Of Treatmentmentioning

confidence: 99%

Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas

Gross¹,

Albuquerque²,

Moon³

et al. 2016

JNS

110

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OBJECTIVEMany small series and technical reports chronicle the evolution of endovascular techniques for cranial dural arteriovenous fistulas (dAVFs) over the past 3 decades, but reports of large patient series are lacking. The authors provide a thorough analysis of clinical and angiographic outcomes across a large patient cohort.METHODSThe authors reviewed their endovascular database from January 1996 to September 2015 to identify patients harboring cranial dAVFs who were treated initially with endovascular approaches. They extracted demographic, presentation, angiographic, detailed treatment, and long-term follow-up data, and they evaluated natural history, initial angiographic occlusion, complications, recurrence, and symptomatic resolution rates.RESULTSAcross a cohort of 251 patients with 260 distinct dAVFs, the overall initial angiographic occlusion rate was 70%; recurrence or occult residual lesions were seen on subsequent angiography in 3% of cases. The overall complication rate was 8%, with permanent neurological complications occurring in 3% of cases. Among 102 patients with dAVFs without cortical venous reflux, rates of resolution/improvement of pulsatile tinnitus and ocular symptoms were 79% and 78%, respectively. Following the introduction of Onyx during the latter half of the study period, the number of treated dAVFs doubled; the initial angiographic occlusion rate increased significantly from 60% before the use of Onyx to 76% after (p = 0.01). In addition, during the latter period compared with the pre-Onyx period, the rate of dAVFs obliterated via a transarterial-only approach was significantly greater (43% vs 23%, p = 0.002), as was the number of dAVFs obliterated via a single arterial pedicle (29% vs 11%, p = 0.002).CONCLUSIONSOverall, in the Onyx era, the rate of initial angiographic occlusion was approximately 80%, as was the rate of meaningful clinical improvement in tinnitus and/or ocular symptoms after initial endovascular treatment of cranial dAVFs.

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Section: Evolution Of Treatmentmentioning

confidence: 99%

Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas

Gross¹,

Albuquerque²,

Moon³

et al. 2016

JNS

110

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“…In symptomatic patients, in whom no spontaneous occlusion of the malformation has occurred, several more or less effective therapeutic approaches have been reported. Treatment of the dAVF to the transverse and sigmoid sinuses includes transarterial or transvenous embolization [10,13,23], surgery [10,24,28,47], radiotherapy [10,49] as well as external compression of the occipital artery [24]. Since some of these procedures bear the potential risk of severe complications, individual criteria for treatment are mandatory.…”

Section: Introductionmentioning

confidence: 99%

Dural arteriovenous fistulas including the transverse and sigmoid sinuses: Results of treatment in 30 cases

Olteanu-Nerbe

E²,

Steiger³

et al. 1997

Acta neurochir

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We report about the treatment and outcome of 30 patients with dural arteriovenous fistulas including the transverse and sigmoid sinuses treated between 1986 and 1995. All patients underwent panangiography for definitive diagnosis. The dAVF were supplied by the external carotid artery system alone (14 patients), both external and internal carotid systems (10 patients) or both anterior and posterior circulation (6 patients). Depending on the venous drainage the fistulas were classified following a modification of Djindjian's description with 18 patients revealing Type I (main sinus with antegrade flow), 5 Type II a (main sinus with reflux into the contralateral sinus). 5 Type II b (cortical veins), 1 Type II a+b (both) and 1 of Type III (direct cortical drainage). Bruit, pulsatile tinnitus and headaches were the most common symptoms. 6 patients presented with intracranial haemorrhage, 4 with progressive neurological deficit or seizures and 3 with dementia. Arterial embolization was performed in all cases except one, where a transvenous approach for balloon occlusion of the transverse sinus was performed. 21 patients were treated by single or repeated embolization alone. Only in 9/21 cases did arterial embolization result in complete occlusion of the fistula. In 12/21 patients incomplete occlusion was achieved. Following embolization 8 patients underwent additional surgery including coagulation of the feeding arteries and arterialized veins, sinus resection and reconstruction of the sinus. Overall, 18 patients were cured, 11 improved and 1 patient was unchanged. There was a total number of 5 complications including transient stroke, transient facial nerve palsy, and a small necrotic skin area following embolization. Venous infarction of the occipital lobe was induced by transvenous occlusion and surgical resection of the transverse sinus in one patient each, respectively. From our results we conclude that the endovascular therapy alone is the treatment of choice in case of Type I fistulas. In dAVF of Type II and III repeated endovascular treatment seems not to be sufficient and additional surgery is necessary.

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“…The therapeutic strategy for DAVFs in adults includes transarterial embolization [3, 4], transvenous embolization [5, 6, 7], and surgical resection of the involved sinus [1, 8]. The most recent developments in the treatment of DAVFs include approaching these lesions through multiple disciplinary treatment of the above modalities and stereotactic radiation [9, 10, 11, 12].…”

Section: Discussionmentioning

confidence: 99%

Embolization of a Giant Torcular Dural Arteriovenous Fistula in a Neonate

Liu¹,

Kuo

1999

Pediatr Neurosurg

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We treated a neonatal infant who presented with heart failure and a giant torcular dural arteriovenous fistula by staged transtorcular embolization with two guidewires, 95 platinum microcoils, and tissue glues through a needle-size craniotomy. Blood loss was minimal. The patient was stable without heart failure after a three-staged embolization. The lesion disappeared on the follow-up angiography done at the age of 3 years. This is the first documented case of neonatal giant torcular dural arteriovenous malformation cured by interventional neuroradiology. The dilemma and strategy in managing this patient will be presented and discussed.

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Surgical treatment of dural arteriovenous malformation in the region of the sigmoid sinus

Cited by 71 publications

References 6 publications

Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas

Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas

Dural arteriovenous fistulas including the transverse and sigmoid sinuses: Results of treatment in 30 cases

Embolization of a Giant Torcular Dural Arteriovenous Fistula in a Neonate

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