Endovascular treatment for dural arteriovenous fistulas in the petroclival region

Abstract

Petroclival region dural arteriovenous fistulas (DAVFs) are rare and difficult lesions to manage. They often have very complex anatomical structures and can be further divided into the superior petrosal sinus, petrous apex, inferior petrosal sinus, upper clival, and upper clival epidural-osseous DAVFs. Most petroclival region DAVFs should be treated due to their high Cognard grades. Currently, endovascular treatment (EVT) has become the first-line therapeutic option for petroclival region DAVFs. But not all the petroclival region DAVFs could be cured with EVT. When the arterial feeders are large or the DAVF is adjacent to the venous sinus, the success rate may be higher. In petroclival region DAVFs, if EVT can be performed successfully, satisfactory outcome can be anticipated. However, there are some inadvertent complications, which include cranial nerve palsy, subsequent sinus thrombosis, and migration embolization of the internal carotid artery and vertebral artery. Currently, a review of the EVT of petroclival region DAVFs is lacking. In this article, we performed a review of the relevant literature on this issue. In addition, some illustrative cases would be provided to elaborate these specific entities.

Is the Middle Meningeal Artery the Optimal Path for Dural Arteriovenous Fistula Embolization?

“…Complications included facial numbness in two cases, blindness in one case, intraoperative or postoperative intracranial hemorrhage in three cases, and postoperative hydrocephalus in one case. Facial numbness, as a form of cranial nerve damage, resulted from the dangerous anastomosis of the MMA, in which the liquid material enters the feeder to affect the geniculate ganglion (16). In the case of blindness, the liquid material entered the ophthalmic artery via the MMA (17).…”

Update on Management of Dural Arteriovenous Fistulas

“…In the modern era, endovascular embolization has become the preferred cranial dAVF treatment modality with either an arterial or venous approach [19,22,[62][63][64][65]. Using specialized coils, embolic agents, or particulates, the dAVF may be partially or fully occluded [6,66,67]. Careful attention must be given before embolization to fully appreciate the anatomical relationships of the dAVF, including the neurological structures supplied by the dAVF feeder arteries, the presence of anastomoses, and dAVF contributions to nervous tissues [58].…”

“…The location of these vascular anomalies is important for risk stratification and prognostication. Spinal dAVF tend to develop in the thoracic spine, while cranial dAVF are most prevalent in the regions of the transverse, sigmoid, and cavernous sinuses [6][7][8][9]. Petroclival dAVF are a rarer but important archetype due to their aggressive nature [6].…”

“…Spinal dAVF tend to develop in the thoracic spine, while cranial dAVF are most prevalent in the regions of the transverse, sigmoid, and cavernous sinuses [6][7][8][9]. Petroclival dAVF are a rarer but important archetype due to their aggressive nature [6]. Tentorial, galenic, and foramen magnum dAVF are among the most complex and highest-risk lesions [4,[10][11][12].…”

Transarterial embolization of dural arteriovenous fistula of the inferior petrosal sinus: A report of two cases

“…Dural arteriovenous fistulas (DAVFs) are abnormal connections between the dural arteries and dural venous sinuses or leptomeningeal veins [ 1 ]. DAVFs often involve the regions of the transverse, sigmoid and cavernous sinuses [ 2 ].…”