Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion

Satomi, Junichiro; Dijk, J. Marc C. van; terBrugge, Karel G.; Willinsky, Robert A.; Wallace, M Christopher

doi:10.3171/jns.2002.97.4.0767

Cited by 257 publications

(216 citation statements)

References 22 publications

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“…We performed a retrospective analysis of all embolisation cases and review of charts and radiographic imaging for patients treated for DAVF after January (1), hydrocephalus (1), sensation of pressure in the head with exercise (1), residual fistula following previous embolisation attempt at a different institution (1) or as an incidental finding on cranial CT (2). The locations of fistulas included tentorial or falcine (4), superior sagittal sinus (4), sphenoparietal sinus (2), sigmoid and transverse sinus (1) and middle cranial fossa (1).…”

Section: Methodsmentioning

confidence: 99%

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Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

Chew

Weill

Guilbert

et al. 2009

Can. j. neurol. sci.

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Intracranial dural arteriovenous fistulas (DAVFs) are lesions with a heterogeneous clinical course, related to the varying patterns of venous drainage. Dural arteriovenous fistulas without cortical venous involvement tend to be relatively benign in course, while lesions with cortical venous drainage (whether direct or via reflux from dural venous sinuses) are more aggressive, having a higher rate of clinical presentation with aggressive neurological symptoms and intracranial haemorr-ABSTRACT: Purpose: To present our experience with the endovascular management of intracranial dural arteriovenous fistulas with direct cortical venous drainage by trans-arterial embolisation using Onyx. Materials & Methods: Between January 2004 and April 2008, 12 consecutive high grade intracranial dural arteriovenous fistulas (Cognard type III (eight patients) or IV (three patients)) were treated by trans-arterial embolisation with Onyx. The majority of cases were treated by Onyx embolisation alone. One case had additional embolisation with n-butyl-2-cyanoacrylate at the same session. Imaging follow-up was obtained in all but one patient (mean 3.6 months). Results: Nine patients had a technical success at the end of the embolisation procedure with complete angiographic exclusion of the fistula. Two patients had a small residual fistula at the end of embolisation, one of which had residual mild cortical venous drainage. Both were stable at follow-up angiography. One patient had a residual fistula supplied by the ophthalmic artery, which was thought to be unsafe to embolise and was sent for surgery, which was curative. In one patient the microcatheter ruptured, with a fragment of the distal microcatheter left in the occipital artery. No clinical complications were observed in this series at clinical follow-up (mean 3.3 months). Two patients were noted to have significant radiation dose. Conclusion: Endovascular management of intracranial dural arteriovenous fistulas with direct venous cortical drainage by trans-arterial Onyx embolisation is a safe and effective treatment according to our experience. Fluoroscopy times and radiation dose may be a concern. Chez un patient une embolisation additionnelle de n-butyl-2-cyanoacrylate (nBCA) a été effectuée au cours de la même session. Une imagerie a été obtenue chez tous les patients sauf un au cours du suivi (moyenne de 3,6 mois). Résultats : Nous avons obtenu un succès technique chez neuf patients à la fin de l'embolisation, avec exclusion angiographique complète de la fistule. Deux patients avaient une petite fistule résiduelle à la fin de l'embolisation, dont un présentait un léger drainage veineux cortical résiduel. Ces deux patients étaient stables à l'angiographie de suivi. Un patient avait une fistule résiduelle nourrie par l'artère ophtalmique dont l'embolisation a été jugée trop risquée. Il a été référé en chirurgie et l'intervention a été un succès. Chez un patient, le microcathéter s'est rompu et un fragment distal du microcathéter s'est logé dans l'artère occipitale. Il a été lai...

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Section: Methodsmentioning

confidence: 99%

“…hage [1][2][3] . The natural history of these high grade lesions has shown to yield a high annual mortality and morbidity rate if untreated 4 .…”

mentioning

confidence: 99%

Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

Chew

Weill

Guilbert

et al. 2009

Can. j. neurol. sci.

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“…1,3,4) The dynamic evolution of DAVF can range from spontaneous occlusion to severe progression. 5, [11][12][13] However, little angiographic evidence of such natural progression is available, especially in patients not subjected to endovascular or surgical treatment. 4,10) One patient with an anterior fossa DAVF had a venous aneurysm which enlarged over 7 years, and the DAVF was treated surgically before bleeding occurred.…”

Section: Introductionmentioning

confidence: 99%

Venous Aneurysm Development Associated With a Dural Arteriovenous Fistula of the Anterior Cranial Fossa With Devastating Hemorrhage-Case Report-

Hashiguchi

Mimata

Ichimura

et al. 2007

Neurol. Med. Chir.(Tokyo)

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A 67-year-old man presented with devastating intracranial hemorrhage (ICH) from an anterior cranial fossa dural arteriovenous fistula (DAVF). Four years earlier, digital subtraction angiography had disclosed a DAVF at the right anterior cranial fossa fed mainly by the ethmoidal branches of the bilateral sphenopalatine arteries and slightly by the ethmoidal arteries of the bilateral ophthalmic arteries, and drained primarily by the sphenoparietal and cavernous sinuses via two dilated cortical veins and slightly by the superior sagittal sinus via a frontal ascending vein. Three-dimensional computed tomography angiography revealed the development of a venous aneurysm on the main draining vein over a 4-year period, but no other changes. Venous aneurysm development may be part of the natural history of DAVF with cortical venous drainage and may contribute to the occurrence of ICH.

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“…Observation or palliative treatment has resulted in a benign and tolerable level of disease in 98.5% of cases. 7 Intra-arterial digital subtraction angiography (DSA) is the standard of reference for the diagnosis *Corresponding author, Phone: +81-96-373-5261, Fax: +81-96-362-4330, E-mail: coralcommunity@yahoo.co.jp of DAVFs. Its high spatial and temporal resolution facilitate the accurate analysis of feeders, venous drainage, and fistula sites.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Intracranial Dural Arteriovenous Fistulas: Comparison of Unenhanced 3T 3D Time-of-flight MR Angiography with Digital Subtraction Angiography

Azuma

Hirai

Shigematsu

et al. 2015

MRMS

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Purpose: We compared gross characterization of intracranial dural arteriovenous fistulas (DAVFs) between unenhanced 3-tesla 3-dimensional (3D) time-of-flight (TOF) magnetic resonance angiography (MRA) and digital subtraction angiography (DSA).Methods: We subjected 26 consecutive patients with intracranial DAVF to unenhanced 3T 3D TOF MRA and to DSA. Two independent sets of observers inspected the main arterial feeders, fistula site, and venous drainage pattern on MRA and DSA images. Interobserver and intermodality agreements were assessed by k statistics.Results: Interobserver agreement was excellent for fistula site (¬ = 0.919; 95% confidence interval [CI], 0.805 to 1.000), good for main arterial feeders (¬ = 0.711; 95% CI, 0.483 to 0.984), and very good for venous drainage (¬ = 0.900; 95% CI, 0.766 to 1.000). Intermodality agreement was excellent for fistula site (¬ = 0.968; 95% CI, 0.906 to 1.000) and good for main arterial feeder (¬ = 0.809; 95% CI, 0.598 to 1.000) and venous drainage (¬ = 0.837; 95% CI, 0.660 to 1.000).Conclusion: Gross characterization of intracranial DAVF was similar for both imaging modalities, but unenhanced 3T 3D TOF MRA cannot replace DSA.

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Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion

Cited by 257 publications

References 22 publications

Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

Venous Aneurysm Development Associated With a Dural Arteriovenous Fistula of the Anterior Cranial Fossa With Devastating Hemorrhage-Case Report-

Evaluation of Intracranial Dural Arteriovenous Fistulas: Comparison of Unenhanced 3T 3D Time-of-flight MR Angiography with Digital Subtraction Angiography

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