Pressure cooker technique in cerebral AVMs and DAVFs: different treatment strategies

Silipigni, Salvatore; Hohenstatt, Sophia; Caranci, Ferdinando; Lanza, Carolina; Carriero, Serena; Vollherbst, Dominik F; Möhlenbruch, Markus; Carrafiello, Gianpaolo; Paolucci, Aldo

doi:10.1007/s11547-023-01605-w

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…(2) The microcatheter should be placed in or close to the fistula to ensure the Onyx glue maximizes diffusion and minimizes distal reflux. When using liquid suppositories such as Onyx gel, reflux can be controlled by repeatedly pausing the injection using the "push and push" technique (35). (3) To reduce complications, care should be taken to protect the important arteries, veins, and venous sinuses intraoperatively (e.g., using the venous sinus balloon technique).…”

Section: Implications For Clinical Practicementioning

confidence: 99%

Endovascular treatment strategy and clinical outcome of tentorial dural arteriovenous fistula

Zhang,

Chang

et al. 2024

Front. Neurol.

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IntroductionTo evaluate treatment strategies and clinical outcomes following endovascular embolization of tentorial dural arteriovenous fistulas.MethodsWe retrospectively analyzed 19 patients with tentorial dural arteriovenous fistulas admitted to the Department of Neurosurgery at Jiangsu Provincial People’s Hospital between October 2015 and May 2022, all treated with endovascular therapy. To collect and analyze patients’ clinical presentation, imaging data, postoperative complications, and prognosis and to analyze the safety and clinical outcomes of endovascular treatment of tentorial dural arteriovenous fistulas.ResultsImaging cure was achieved in 18 patients, with the arterial route chosen for embolization in 17 patients and the venous route in one patient; one patient received partial embolization. Staged embolization was performed in four patients. At postoperative follow-up of 9–83 months (37.8 ± 21.2), all 19 patients had recovered well (mRS score ≤ 2). Three patients experienced perioperative complications: intraoperative Onyx reflux into the middle cerebral artery in one patient; postoperative permanent limited left visual field loss and deafness in the left ear in one patient; and transient diplopia, vertigo, and decreased pain and temperature sensation of the left limb in one patient, with no abnormalities on post-procedure magnetic resonance examinations. A total of 17 patients completed a postoperative digital subtraction angiography review during follow-up, and one patient had a recurrence of an arteriovenous fistula.ConclusionEndovascular treatment of tentorial dural arteriovenous fistulas is safe and effective. Reduction of the Borden or Cognard classification via eliminating cortical venous reflux through multi-staged embolization or combined open surgery is a reasonable goal of treatment where complete obliteration of the fistula is not achievable.

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Section: Implications For Clinical Practicementioning

confidence: 99%

Endovascular treatment strategy and clinical outcome of tentorial dural arteriovenous fistula

Zhang,

Chang

et al. 2024

Front. Neurol.

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Adenosine-assisted embolization of cerebral arteriovenous malformations: a systematic review and meta-analysis

Bocanegra-Becerra,

Andreão,

Acha Sánchez

et al. 2024

J NeuroIntervent Surg

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BackgroundCerebral arteriovenous malformations (AVMs) are complex lesions that can cause hemorrhagic stroke and significant neurological disability. Adenosine induces cardiac standstill and hypotension, which are thought to be useful during cerebral AVM embolization. Herein, we conducted a systematic review and meta-analysis of the technique’s safety.MethodsFollowing PRISMA guidelines, four databases were queried for studies describing the use of adenosine-assisted embolization of cerebral AVMs. Adenosine-related intraoperative complications, permanent neurological outcomes, morbidity, and mortality assessed the technique’s safety. Single proportion analysis under a random-effects model was performed. Heterogeneity was assessed using I² statistics, and publication bias was evaluated through funnel plot analysis and Egger’s regression test.ResultsTen studies were included, involving 79 patients (55.7% male) with 79 AVMs (54.4% unruptured and 70.9% Spetzler–Martin grade III-V) who underwent 123 embolizations (80.4% and 5.9% under transarterial and transvenous approaches, respectively) with n-butyl cyanoacrylate (80.4%), ethylene vinyl alcohol (14.4%), or both (5.2%). The incidence of transient adenosine-related intraoperative complications was 0% (95% CI 0% to 3%, I2=24%). Besides, the incidence of adenosine-related morbidity, mortality, and permanent outcomes was 0% (95% CI 0% to 3%, I2=0%). During follow-up, good functional outcomes were reported for 64 patients (81%).ConclusionsAdenosine’s effects on blood flow control can facilitate embolization and mitigate the risk of AVM rupture and embolic agent migration. Although current evidence stems from observational studies, the results of this meta-analysis suggest a safe drug profile due to minimal associated morbidity and mortality. Further research from larger randomized and controlled studies is warranted to attain a higher level of evidence.PROSPERO registry numberCRD42023494116

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Pressure cooker technique in cerebral AVMs and DAVFs: different treatment strategies

Cited by 2 publications

References 14 publications

Endovascular treatment strategy and clinical outcome of tentorial dural arteriovenous fistula

Endovascular treatment strategy and clinical outcome of tentorial dural arteriovenous fistula

Adenosine-assisted embolization of cerebral arteriovenous malformations: a systematic review and meta-analysis

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