Stereotactic Radiosurgery and Particulate Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

Pollock, Bruce E.; Nichols, Douglas A.; Garrity, James A.; Gorman, Deborah A.; Stafford, Scott L.

doi:10.1097/00006123-199909000-00008

Cited by 140 publications

(75 citation statements)

References 26 publications

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“…Although there are different transvenous routes to the cavernous sinus, i.e., by way of the inferior petrosal sinus, contralateral inferior petrosal sinus, basilar plexus or circular sinus, through the facial vein, angular vein, superior ophthalmic vein, superior petrosal sinus, or through the pterygoid plexus, the facial vein and the inferior petrosal sinus are frequently used 3,5,9,10,21,23,25,28 . Transvenous embolization is currently our treatment of choice for symptomatic DAVF of the cavernous sinus that require prompt therapy.…”

Section: Transvenous Embolizationmentioning

confidence: 99%

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Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

Zhang

Jiang

et al. 2010

Interv Neuroradiol

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We report on the safety and efficacy of transarterial and transvenous Onyx embolization in the treatment of dural arteriovenous fistulae (DAVFs) of the cavernous sinus. We reviewed the findings from a retrospectively database for 22 patients with cavernous sinus DAVFs who were treated with either transarterial Onyx embolization alone (n = 8) or transarterial and transvenous Onyx embolization (n = 14) over a four year period. The mean follow-up period after endovascular treatment was 21.6 months (range 3–42 mths). Total number of embolizations was 27 for 22 patients. Two patients were treated transvenously after transarterial embolization. All 22 patients (100%) experienced improvement of their clinical symptoms. All 22 patients (100%) experienced total obliteration of their DAVFs, as documented by angiography performed at a mean follow-up of 5.8 months after the last treatment. No patient experienced a recurrence of symptoms after angiography showed DAVF obliteration. One patient exhibited temporary deterioration of ocular symptoms secondary to venous hypertension after near total obliteration; one had transient V cranial nerve deficit related to transarterial embolization, and two patients exhibited transient III and VI cranial nerve weakness related to transvenous embolization. Two patients experienced recurrent symptoms after incomplete transarterial embolization and underwent transvenous embolization at three and four months. Both patients achieved clinical and angiographic cures. Transarterial and transvenous embolization with Onyx, whenever possible, proved to be a safe and effective management for patients with cavernous sinus DAVFs.

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Section: Transvenous Embolizationmentioning

confidence: 99%

“…Patients without any accessible arterial and venous approaches can be treated using gamma knife radiosurgery, complete obliteration can be achieved in 80%-90% cases of cavernous sinus DAVFs, obtained six to 15 months after radiosurgery (23).…”

Section: Radiosurgerymentioning

confidence: 99%

Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

Zhang

Jiang

et al. 2010

Interv Neuroradiol

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“…7,12,22,23,35,39,51 Although endovascular embolization may provide immediate symptomatic relief and reduction of hemorrhage risk, the treatment may not afford longterm cure in cases of subtotal obliteration or delayed recanalization. 24 Therefore, SRS serves as a complementary treatment by potentially increasing the likelihood of permanent DAVF occlusion.…”

mentioning

confidence: 99%

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

Chen¹,

Lee

Ding³

et al. 2015

JNS

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C urrent treatment strategies for intracranial dural arteriovenous fistulas (DAVFs) include microsurgical ligation, transarterial or transvenous embolization, stereotactic radiosurgery (SRS), and various combinations of these therapeutic options. Endovascular therapy, most commonly performed via transvenous routes, has become the preferred treatment approach for DAVFs. 27,44,48 Due to the immediate obliteration that can be achieved with endovascular or surgical occlusion, SRS is typically reserved for lesions that cannot be obliterated with endovascular or surgical approaches, or for patients who pose a high surgical risk due to medical comorbidities. Therefore, published SRS series for DAVFs remain relatively few and comprise mostly retrospective, single-center studies.In this systematic review, we evaluate the obliteration rate of DAVFs in patients treated with SRS. We also compare obliteration rates between cavernous sinus (CS) and noncavernous sinus (NCS) DAVFs, and between DAVFs with and without cortical venous drainage (CVD), by using available data in the literature. Methods inclusion CriteriaIn our attempt to balance between the largest possible patient population and a relatively homogeneous cohort, the following inclusion criteria for this systematic review were devised: 1) the study must contain at least 5 patients abbreviatioNs AVM = arteriovenous malformation; CS = cavernous sinus; CVD = cortical venous drainage; DAVF = dural arteriovenous fistula; GKS = Gamma Knife surgery; LINAC = linear accelerator; NCS = noncavernous sinus; SRS = stereotactic radiosurgery; TSS = transverse and sigmoid sinus. obJeCt The goal of this study was to evaluate the obliteration rate of intracranial dural arteriovenous fistulas (DAVFs) in patients treated with stereotactic radiosurgery (SRS), and to compare obliteration rates between cavernous sinus (CS) and noncavernous sinus (NCS) DAVFs, and between DAVFs with and without cortical venous drainage (CVD). Methods A systematic literature review was performed using PubMed. The CS DAVFs and the NCS DAVFs were categorized using the Barrow and Borden classification systems, respectively. The DAVFs were also categorized by location and by the presence of CVD. Statistical analyses of pooled data were conducted to assess complete obliteration rates in CS and NCS DAVFs, and in DAVFs with and without CVD. results Nineteen studies were included, comprising 729 patients harboring 743 DAVFs treated with SRS. The mean obliteration rate was 63% (95% CI 52.4%-73.6%). Complete obliteration for CS and NCS DAVFs was achieved in 73% and 58% of patients, respectively. No significant difference in obliteration rates between CS and NCS DAVFs was found (OR 1.72, 95% CI 0.66-4.46; p = 0.27). Complete obliteration in DAVFs with and without CVD was observed in 56% and 75% of patients, respectively. A significantly higher obliteration rate was observed in DAVFs without CVD compared with DAVFs with CVD (OR 2.37, 95% CI 1.07-5.28; p = 0.03). CoNClusioNs Treatment with SRS offers favorable rates of D...

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“…Transient neurological deficits due to treatment occur in up to 10% [153][154][155], and serious neurological complications have been reported [156]. Questions also remain regarding the long-term efficacy of occlusion following radiosurgery, with recurrences reported after complete angiographic obliteration [157].…”

Section: Treatmentmentioning

confidence: 99%

Central Nervous System Vascular Malformations

Davidson¹,

Stoodley²

2012

Congenital Anomalies - Case Studies and Mechanisms

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Stereotactic Radiosurgery and Particulate Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

Cited by 140 publications

References 26 publications

Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

Transarterial and Transvenous Embolization for Cavernous Sinus Dural Arteriovenous Fistulae

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

Central Nervous System Vascular Malformations

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