Anterior Cranial Fossa Dural Arteriovenous Fistulae – Angioarchitecture and Intervention

Kulanthaivelu, Karthik; Pendharkar, Hima; Prasad, Chandrajit; Gupta, Arun Kumar; Ramalingaiah, Arvinda Hanumanthapura; Saini, Jitender; Srinivas, Dwarakanath

doi:10.1007/s00062-020-00932-z

Cited by 15 publications

(8 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This retrospective single-center study provides detailed dosimetry data for the endovascular treatment of intracranial LDAVF in 70 patients between 2014 and 2019. In particular, we believe that the strict selection criteria (e.g., exclusion of other intracranial fistulae, such as carotid-cavernous fistula [ 17 ] or anterior cranial fossa DAVF [ 18 ]) as well as the dedicated consideration of both the Cognard grade and endovascular technique (TA liquid embolization with EVOH and/or TV coil embolization) is unique and may therefore be valuable in order to introduce novel DRLs in the field of interventional neuroradiology considering the paramount impact of the Euratom Basic Safety Standards directive [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae

et al. 2020

View full text Add to dashboard Cite

Purpose Intracranial lateral dural arteriovenous fistula (LDAVF) represents a specific subtype of cerebrovascular fistulae, harboring a potentially life-threatening risk of brain hemorrhage. Fluoroscopically guided endovascular embolization is the therapeutic gold standard. We provide detailed dosimetry data to suggest novel diagnostic reference levels (DRL). Methods Retrospective single-center study of LDAVFs treated between January 2014 and December 2019. Regarding dosimetry, the dose area product (DAP) and fluoroscopy time were analyzed for the following variables: Cognard scale grade, endovascular technique, angiographic outcome, and digital subtraction angiography (DSA) protocol. Results A total of 70 patients (19 female, median age 65 years) were included. Total median values for DAP and fluoroscopy time were 325 Gy cm2 (25%/75% percentile: 245/414 Gy cm2) and 110 min (68/142min), respectively. Neither median DAP nor fluoroscopy time were significantly different when comparing low-grade with high-grade LDAVF (Cognard I + IIa versus IIb–V; p > 0.05, each). Transvenous coil embolization yielded the lowest dosimetry values, with significantly lower median values when compared to a combined transarterial/transvenous technique (DAP 290 Gy cm2 versus 388 Gy cm2, p = 0.031; fluoroscopy time 85 min versus 170 min, p = 0.016). A significant positive correlation was found between number of arterial feeders treated by liquid embolization and both DAP (rs = 0.367; p = 0.010) and fluoroscopy time (rs = 0.295; p = 0.040). Complete LDAVF occlusion was associated with transvenous coiling (p = 0.001). A low-dose DSA protocol yielded a 20% reduction of DAP (p = 0.021). Conclusion This LDAVF study suggests several local DRLs which varied substantially dependent on the endovascular technique and DSA protocol.

show abstract

Section: Discussionmentioning

confidence: 99%

Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Hemorrhage at presentation significantly increases the risk of poor clinical outcomes,3 and is associated with ensuing morbidity and mortality 4. Due to their high risk of hemorrhage, these lesions warrant aggressive treatment even when found incidentally 5–8. The angioarchitecture of these lesions with venous outflow through fragile pial veins increases the risk of hemorrhage 5–8.…”

Section: Introductionmentioning

confidence: 99%

“…Due to their high risk of hemorrhage, these lesions warrant aggressive treatment even when found incidentally 5–8. The angioarchitecture of these lesions with venous outflow through fragile pial veins increases the risk of hemorrhage 5–8. The lack of large venous sinuses in the anterior fossa makes pial veins the de facto draining structures of ACF-dAVFs.…”

Section: Introductionmentioning

confidence: 99%

Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

Sanchez

Raghuram

Wendt

et al. 2022

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundAnterior cranial fossa dural arteriovenous fistulas (ACF-dAVFs) are aggressive vascular lesions. The pattern of venous drainage is the most important determinant of symptoms. Due to the absence of a venous sinus in the anterior cranial fossa, most ACF-dAVFs have some degree of drainage through small cortical veins. We describe the natural history, angiographic presentation and outcomes of the largest cohort of ACF-dAVFs.MethodsThe CONDOR consortium includes data from 12 international centers. Patients included in the study were diagnosed with an arteriovenous fistula between 1990–2017. ACF-dAVFs were selected from a cohort of 1077 arteriovenous fistulas. The presentation, angioarchitecture and treatment outcomes of ACF-dAVF were extracted and analyzed.Results60 ACF-dAVFs were included in the analysis. Most ACF-dAVFs were symptomatic (38/60, 63%). The most common symptomatic presentation was intracranial hemorrhage (22/38, 57%). Most ACF-dAVFs drained through cortical veins (85%, 51/60), which in most instances drained into the superior sagittal sinus (63%, 32/51). The presence of cortical venous drainage predicted symptomatic presentation (OR 9.4, CI 1.98 to 69.1, p=0.01). Microsurgery was the most effective modality of treatment. 56% (19/34) of symptomatic patients who were treated had complete resolution of symptoms. Improvement of symptoms was not observed in untreated symptomatic ACF-dAVFs.ConclusionMost ACF-dAVFs have a symptomatic presentation. Drainage through cortical veins is a key angiographic feature of ACF-dAVFs that accounts for their malignant course. Microsurgery is the most effective treatment. Due to the high risk of bleeding, closure of ACF-dAVFs is indicated regardless of presentation.

show abstract

“…These feeding arteries gathered in the sphenoid bone and then anastomosed with the right ascending pharyngeal artery in the clivus of the occipital bone, with the feeding arteries running a relatively long distance and flowing into the shunted pouch in the left jugular tubercle. Kulanthaivelu et al 6 examined the angiography images of seven cases of anterior cranial fossa AVF and confirmed that the sphenopalatine artery was the feeding artery in three (42.9%) of seven cases, suggesting that the sphenopalatine artery is the main feeding artery of the anterior cranial fossa AVF near the nasal cavity. 7 Furthermore, in AVFs formed within the sphenoid bone, the peripheral part of the internal maxillary artery has been identified as the main feeding artery.…”

Section: Discussionmentioning

confidence: 90%

Anterior condylar arteriovenous fistula mainly fed by peripheral branches of the bilateral internal maxillary arteries: illustrative case

Kimura,

Ikeda,

Nishi

et al. 2023

Journal of Neurosurgery: Case Lessons

View full text Add to dashboard Cite

BACKGROUND The main feeding artery of an anterior condylar arteriovenous fistula (AC-AVF) is the ascending pharyngeal artery and rarely the internal maxillary artery. OBSERVATIONS A 58-year-old male with a history of sinusitis since adolescence presented with a 5-year history of bilateral pulsatile tinnitus and a 2-month history of right ocular symptoms. Angiography showed that the peripheral branches of the bilateral internal maxillary arteries were the main feeding arteries of the AC-AVF and that they gathered in the clivus with a relatively large shunted pouch in the left jugular tubercle. Shunt flow drained to the right external jugular vein via the right superior ophthalmic vein. A sheath was placed in the right external jugular vein, and a small distal access catheter was guided to the right superior ophthalmic vein to allow the microcatheter to reach the shunted pouch. Selective angiography of the contralateral sphenopalatine artery allowed us to confirm the gathering site of the feeding arteries and the shunted pouch and archive the complete occlusion. LESSONS Selective angiography of the contralateral sphenopalatine artery may be useful to confirm the gathering site of the peripheral branches of the bilateral internal maxillary arteries in an AC-AVF.

show abstract

Anterior Cranial Fossa Dural Arteriovenous Fistulae – Angioarchitecture and Intervention

Cited by 15 publications

References 33 publications

Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae

Radiation Dose and Fluoroscopy Time of Endovascular Treatment in Patients with Intracranial Lateral Dural Arteriovenous Fistulae

Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

Anterior condylar arteriovenous fistula mainly fed by peripheral branches of the bilateral internal maxillary arteries: illustrative case

Contact Info

Product

Resources

About