Treatment of Intracranial Dural Arteriovenous Fistulas: Current Strategies Based on Location and Hemodynamics, and Alternative Techniques of Transcatheter Embolization

Kiyosue, Hiro; Hori, Yuzo; Okahara, Mika; Tanoue, Shuichi; Sagara, Yoshiko; Matsumoto, Shunro; Nagatomi, Hirofumi; Mori, Hiromu

doi:10.1148/rg.246045026

Cited by 198 publications

(181 citation statements)

References 61 publications

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“…These fistulae arise spontaneously and generally affect the middle-aged population 6 . Cavernous sinus DAVFs occur less frequently than transverse/sigmoid sinus DAVFs and have a low risk of hemorrhage 10 . Patients with cavernous sinus DAVFs may develop an alarming symptom complex consisting of proptosis, che mosis, extraocular muscle palsies, and, sometimes, threatened visual loss resulting from either increased intraocular pressure or reduced ocular perfusion pressure 1,4,22 .…”

Section: Introductionmentioning

confidence: 99%

“…For these patients, rapid curative treatment is necessary to prevent visual deterioration, in addition to diplopia and intracranial bruits 4 . Management of cavernous sinus DAVFs has included observation, intermittent manual compression of the ICA, stereotactic radiosurgery, transarterial or transvenous embolization and neurosurgery 8,10,11,12,14,21,27 . Endovascular techniques have become the most common treatment for patients with symptomatic cavernous sinus DAVFs that do not spontaneously resolve, because of the high rates of cure after emboliza-A B C D tion 2,6,10,14,24 .…”

Section: Introductionmentioning

confidence: 99%

“…Management of cavernous sinus DAVFs has included observation, intermittent manual compression of the ICA, stereotactic radiosurgery, transarterial or transvenous embolization and neurosurgery 8,10,11,12,14,21,27 . Endovascular techniques have become the most common treatment for patients with symptomatic cavernous sinus DAVFs that do not spontaneously resolve, because of the high rates of cure after emboliza-A B C D tion 2,6,10,14,24 . However, embolization of cavernous sinus DAVFs has been reported to cause at least temporary ophthalmoplegia in eight to 50% of patients 1,20 , and recanalization of embolized DAVFs is well documented 26 .…”

Section: Introductionmentioning

confidence: 99%

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Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

Zhang

Jiang

et al. 2010

Interv Neuroradiol

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We report on the safety and efficacy of transarterial and transvenous Onyx embolization in the treatment of dural arteriovenous fistulae (DAVFs) of the cavernous sinus. We reviewed the findings from a retrospectively database for 22 patients with cavernous sinus DAVFs who were treated with either transarterial Onyx embolization alone (n = 8) or transarterial and transvenous Onyx embolization (n = 14) over a four year period. The mean follow-up period after endovascular treatment was 21.6 months (range 3–42 mths). Total number of embolizations was 27 for 22 patients. Two patients were treated transvenously after transarterial embolization. All 22 patients (100%) experienced improvement of their clinical symptoms. All 22 patients (100%) experienced total obliteration of their DAVFs, as documented by angiography performed at a mean follow-up of 5.8 months after the last treatment. No patient experienced a recurrence of symptoms after angiography showed DAVF obliteration. One patient exhibited temporary deterioration of ocular symptoms secondary to venous hypertension after near total obliteration; one had transient V cranial nerve deficit related to transarterial embolization, and two patients exhibited transient III and VI cranial nerve weakness related to transvenous embolization. Two patients experienced recurrent symptoms after incomplete transarterial embolization and underwent transvenous embolization at three and four months. Both patients achieved clinical and angiographic cures. Transarterial and transvenous embolization with Onyx, whenever possible, proved to be a safe and effective management for patients with cavernous sinus DAVFs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

Zhang

Jiang

et al. 2010

Interv Neuroradiol

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“…The posterolateral type involves draining routes from the cavernous sinus through the superior petrosal sinus, petrosal vein and lateral mesencephalic vein and/or anterior pontomesencephalic vein to the basal cerebral vein, and may also drain into the cerebellar veins. Some authors mentioned that this type of deep drainage results in potential risks of cerebral symptoms [6,15]. The posteromedial type is characterized by a draining route from the cavernous sinus via the prepontine bridging vein, transverse pontine vein, and/or anterior pontomesencephalic vein into the basal cerebral vein.…”

Section: Discussionmentioning

confidence: 99%

Basal cerebral venous drainage from cavernous sinus dural arteriovenous fistulas

et al. 2008

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Introduction This study aimed to define the patterns of basal cerebral venous drainage (BCVD) from cavernous sinus dural arteriovenous fistulas (CSDAVFs). Materials and methods Forty sets of selective angiographic data from 36 patients with spontaneous CSDAVFs (age range, 53-79 years) were retrospectively analyzed for their drainage patterns. Three types of BCVD were observed, i.e., superolateral type, BCVD via the deep middle cerebral vein or uncal vein; posterolateral type, BCVD via the superior petrosal sinus and petrosal vein; and posteromedial type, BCVD via the bridging vein and the anterior pontomesencephalic vein. MR images and/or 3D-DSA images were also reviewed when available. Results BCVD from CSDAVF was found in 12 patients (30%), and the other drainage routes included the superior ophthalmic vein in 25 (63%), the inferior petrosal sinus in 17 (43%), the superficial middle cerebral vein in 17 (43%), intercavernous sinus in 15 (38%), the superior petrosal sinus in seven (18%), and pterygoid plexus in two (5%), respectively. In 12 patients with BCVD, superolateral type was found in four (33%), posterolateral type in five (42%), and posteromedial type in seven (58%). Four cases of posteromedial type were associated with other types of BCVD. Conclusion CSDAVFs are often associated with BCVD via three different pathways. The posteromedial type via the bridging vein is the most frequent type of BCVD.

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“…3 At present, transvenous embolization (TVE) has been widely accepted as a useful treatment for DAVFs. 4 Anatomical obliteration rates with TVE have been reported to range from 63% to 87.5%, and the clinical cure rates from 83% to 96%.…”

Section: Introductionmentioning

confidence: 99%

Recurrence of the cavernous sinus dural arteriovenous fistula at adjacent sinuses following repeated transvenous embolizations: case report and literature review

et al. 2008

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We present a unique case of a cavernous sinus (CS) dural arteriovenous fistula (DAVF), which recurred at adjacent sinuses following repeated transvenous embolizations (TVEs).A 68-year-old woman presented progressive left conjunctival chemosis and diplopia.Cerebral angiography revealed a left CS DAVF, which was completely obliterated by TVE via the left inferior petrosal sinus (IPS). Two years later, the DAVF recurred in the left IPS, and in the left sigmoid sinus (SS) three years after the initial treatment in spite of second TVE.Moreover, the left SS and the left internal jugular vein, which had been previously stenotic, have been occluded. The third TVE resulted in the complete obliteration of the SS DAVF.CS DAVFs may recur at adjacent sinuses even after complete obliteration by TVE. Careful follow-up is necessary to check for the recurrence of DAVFs especially in cases with venous flow changes, such as sinus occlusion, following endovascular treatments.

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Treatment of Intracranial Dural Arteriovenous Fistulas: Current Strategies Based on Location and Hemodynamics, and Alternative Techniques of Transcatheter Embolization

Cited by 198 publications

References 61 publications

Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

Basal cerebral venous drainage from cavernous sinus dural arteriovenous fistulas

Recurrence of the cavernous sinus dural arteriovenous fistula at adjacent sinuses following repeated transvenous embolizations: case report and literature review

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