Analysis of the best therapeutic alternative for intracranial dural arteriovenous malformations

Abstract

-The material for this re s e a rch consisted of 93 patients with dural arteriovenous malform a t i o n s ( D AVMs) who were studied re t rospectively with regards to therapeutic success and failure, who had undergone either neuro s u rg e ry, or embolization or a combination of both methods and whose disease was located in the cavernous sinus, the superior sagittal sinus, the transverse-sigmoid sinus of the anterior fossa and the tentorium. Thus, it was possible to arrive at the following conclusions: treatment of the DAVMs must be indicated, jointly, by an interventionist neuroradiologist and a neuro s u rgeon; DAVMs of the transversesigmoid sinus were better treated when a combination of both methods was used; DAVMs of the tentorium were also better treated with a combined method; the endovascular method ensured only a 50% chance of therapeutic success for DAVMs of the superior sagittal sinus; DAVMs of the cavernous sinus are better treated when the endovascular method was used with a transvenous approach, relative to the transarterial approach.KEY WORDS: dural arteriovenous malformation, endovascular therapy, neurosurgical therapy.Análise da melhor alternativa terapêutica para malformações arteriovenosas durais intracranianas RESUMO -O material utilizado consistiu de 93 pacientes port a d o res de malformações arteriovenosas durais ( M AVDs) estudados re t rospectivamente em relação ao sucesso e ao fracasso terapêutico submetidos aos métodos neurocirúrgico ou endovascular ou, ainda, combinação entre ambos, em que a doença se localizou nas regiões do seio cavernoso, do seio sagital superior, do seio transverso-sigmóide, da fossa anterior e do tentório. As conclusões foram as seguintes: o tratamento das MAVDs deve ser indicado pelo neurorradiologista intervencionista e pelo neurocirurgião, conjuntamente; as MAVDs do seio transverso-sigmóide foram melhor tratadas através do método combinado; as MAVDs do tentório foram melhor tratadas através do método combinado; as MAVDs do seio sagital superior tratadas por método endovascular asseguraram apenas 50% de sucesso terapêutico; as MAVDs do seio cavernoso são melhor tratadas por método endovascular empregando-se a via transvenosa quando comparadas com a via transarterial. PALAVRAS-CHAVE: malformação arteriovenosa dural, método endovascular, método neurocirúrgico. Dural arteriovenous malformations (DAV M s ) a re rare and re p resent 10% to 15% of all intracranial arteriovenous malform a t i o n s 1 -5 . DAVMs are complex lesions that need to be evaluated carefully so that the best therapeutic option can be d e t e rmined, particularly when their biphasic behavior is considere d 6 , 7

Dural arteriovenous fistula presenting as thalamic dementia

“…Capillary beds usually interposed are lacking 7 . Intracranial dural AVF represent approximately 10% to 15% of all intracranial vascular malformations 8,9,[11][12][13] . Since the posterior fossa dural AVF and subsequent venous hypertension is important to be considered in the different diagnosis of thalamic lesions 14 , we report an unique case of thalamic dementia associated with venous hypertension in the bilateral thalamus due to a dural AVF that was successfully treated by endovascular procedures.…”