Role of Surgical Intervention for Intracranial Dural Arteriovenous Fistulas With Cortical Venous Drainage in an Endovascular Era: A Case Series

2020 ◽  
Author(s):  
Yosuke Akamatsu ◽  
Santiago Gomez-Paz ◽  
David Vergara-Garcia ◽  
Viraj M Moholkar ◽  
Anna Luisa Kuhn ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Surgical Intervention ◽  
Transarterial Embolization ◽  
Case Series ◽  
Venous Drainage ◽  
Surgical Approaches ◽  
Surgical Interventions ◽  
Cortical Vein ◽  
Complete Obliteration ◽  
Cortical Venous Drainage

Abstract BACKGROUND Intracranial dural arteriovenous fistulae (dAVFs) with cortical venous drainage (CVD) require treatment because of their aggressive clinical presentation and natural history. Although endovascular treatment is effective for the majority of these lesions in the current endovascular era, surgical management has been required if the lesions are not amenable to or fail endovascular treatments. OBJECTIVE To demonstrate the angioarchitecture that may necessitate surgical intervention. METHODS A retrospective review of the patients with intracranial dAVFs with CVD treated at 2 academic institutions between January 1, 2009, and July 31, 2019 was performed. Patients who required surgical intervention were selected in this study, and angiographic findings were analyzed. RESULTS A total of 81 dAVFs in 80 patients were treated during the study period. Endovascular treatments were attempted for 72 (88.9%) dAVFs, resulting in complete obliteration in 55 (76.4%). Surgical interventions were performed in 18 (22.2%) dAVFs, resulting in complete obliteration in all lesions. Overall, complete obliteration was achieved in 74 (93.7%) of 79 dAVFs with follow-up. In the surgically treated dAVFs, curative transarterial embolization was deterred by the angioarchitecture, which included dominant feeding vessels from the ophthalmic artery, meningohypophyseal trunk, posterior meningeal artery, pial artery, or ascending pharyngeal artery. Drainage through tortuous cortical vein, deep venous system, or isolated sinus made transvenous approach challenging. CONCLUSION Despite continued improvement in endovascular technology, surgical approaches to dAVFs are still of great value as initial and salvage treatment of dAVFs with angioarchitecture hampering endovascular treatment.

scholarly journals Dural arteriovenous fistulas with direct cortical venous drainage treated with Onyx®: a case series

2010 ◽  
Vol 68 (4) ◽  
pp. 613-618 ◽  
Author(s):  
Felipe Padovani Trivelato ◽  
Daniel Giansante Abud ◽  
Alexandre Cordeiro Ulhôa ◽  
Tiago de Jesus Menezes ◽  
Thiago Giansante Abud ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Transarterial Embolization ◽  
Case Series ◽  
Venous Drainage ◽  
Complete Occlusion ◽  
Arteriovenous Fistulas ◽  
Type Iv ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

Dural arteriovenous fistulas (DAVFs) may have aggressive symptoms, especially if there is direct cortical venous drainage. We report our preliminary experience in transarterial embolization of DAVFs with direct cortical venous drainage (CVR) using Onyx®. METHOD: Nine patients with DAVFs with direct cortical venous drainage were treated: eight type IV and one type III (Cognard). Treatment consisted of transarterial embolization using Onyx-18®. Immediate post treatment angiographies, clinical outcome and late follow-up angiographies were studied. RESULTS: Complete occlusion of the fistula was achieved in all patients with only one procedure and injection in only one arterial pedicle. On follow-up, eight patients became free from symptoms, one improved and no one deteriorated. Late angiographies showed no evidence of recurrent DAVF. CONCLUSION: We recommend that transarterial Onyx® embolization of DAVFs with direct cortical venous drainage be considered as a treatment option, while it showed to be feasible, safe and effective.

scholarly journals Dural Arteriovenous Fistula within Superior Sagittal Sinus Wall with Direct Cortical Venous Drainage: A Systematic Literature Review

2021 ◽  
Author(s):  
Rajendra Chavan ◽  
Shreya Sethi ◽  
Harsha Sahu ◽  
Neeraj Rao ◽  
Shivani Agarwal
Keyword(s):  
Literature Review ◽  
Treatment Option ◽  
Systematic Literature Review ◽  
Superior Sagittal Sinus ◽  
English Literature ◽  
Venous Drainage ◽  
Sagittal Sinus ◽  
Complete Obliteration ◽  
Cortical Venous Drainage ◽  
Special Subgroup

AbstractDural arteriovenous fistulas (DAVFs) located within superior sagittal sinus (SSS) wall with direct cortical venous drainage are rare. They are also known as variant DAVF (vDAVF) and form a special subgroup of DAVFs. Their chance of presenting with aggressive features is high compared with transverse sigmoid sinus fistula. They drain directly into cortical veins (Borden type 3, Cognard type III and IV). A systematic English literature review of SSS vDAVF was made. Systematic literature review revealed a total of 31 published cases. These were commonly seen in male population, (24 males, 77.41%, 24/31). Average age of patients was 54 years. A total of 24 patients (77.41%, 24/31) had aggressive clinical presentations with 13 patients (41.93%, 13/31) having intracranial hemorrhages (ICH). Two patients had rebleeding (15.38%, 2/13). Middle portion of SSS was commonly involved (15 cases, 75%). A total of 25 (96.15%, 25/26) cases had patent SSS. Most of the fistulas were idiopathic (65.38%, 17/26), with trauma being a frequent etiological factor (26.92%, 7/26). Venous ectasia was seen in 19 patients (59.37%, 19/32). Middle meningeal arterial (MMA) supply was seen in all patients (100%, 26/26), with bilateral MMA supply in 21 cases (80.76%), and unilateral in 5 cases (19.23%). Twenty patients (62.50%, 20/32) received only endovascular treatment (EVT), while four patients had EVT followed by surgery (12.5%, 4/32). Transarterial route via MMA was the preferred treatment option (79.16%). Complete obliteration of fistulas was noted in all cases (100%, 30/30). No immediate complication was noted after EVT. As much as 92.30% patients showed good recovery. Thus, SSS vDAVF forms a special subgroup of DAVF, with aggressive presentation, and warrants urgent treatment. EVT is effective treatment option and can produce complete obliteration.

Pharmacological treatment of hepatocellular carcinoma with cavoatrial tumor thrombus – case series and literature review

2019 ◽  
Vol 57 (04) ◽  
pp. 501-507 ◽  
Author(s):  
Tianzuo Zhan ◽  
Janina Sollors ◽  
Niels Steinebrunner ◽  
Hans Schlitt ◽  
Christian Stroszczynski ◽  
...  
Keyword(s):  
Tumor Thrombus ◽  
Systemic Treatment ◽  
Treatment Options ◽  
Survival Rates ◽  
Vena Cava ◽  
Case Series ◽  
Surgical Approaches ◽  
Surgical Interventions ◽  
Advanced Hcc ◽  
Multimodal Therapy Concept

AbstractHepatocellular carcinomas (HCC) that extend into the vena cava and the right atrium have a poor prognosis. Surgical approaches including partial hepatectomy and thrombectomy are the most frequently reported treatment options. However, most patients with advanced HCC are not eligible for complex surgical interventions due to reduced liver function, comorbidities, and metastases. At the same time, systemic treatment options of HCC have expanded in recent years. Here, we report 3 cases of patients with advanced HCC who developed a cavoatrial tumor thrombus (CATT) after initial surgical or interventional therapy. The patients were consequently treated with sorafenib or nivolumab. In all cases, the tumor responded to systemic treatment with disease stabilization or partial regression. Overall survival after diagnosis of CATT was 3 and 17 months for sorafenib and 7 + months for nivolumab. Compared to survival rates of alternative treatment options, systemic therapies demonstrated comparable outcomes. In summary, pharmacotherapy is an efficient and well worth option to treat patients with HCC and CATT and should be an integral part of a multimodal therapy concept.

A new transvenous approach to the carotid-cavernous sinus via the inferior petrooccipital vein

2012 ◽  
Vol 116 (3) ◽  
pp. 581-587 ◽  
Author(s):  
Akira Kurata ◽  
Sachio Suzuki ◽  
Kazuhisa Iwamoto ◽  
Kuniaki Nakahara ◽  
Madoka Inukai ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Venous Drainage ◽  
Inferior Petrosal Sinus ◽  
Superior Ophthalmic Vein ◽  
Carotid Cavernous Fistula ◽  
Cushing Disease ◽  
Cortical Vein ◽  
The Third ◽  
Cortical Venous Drainage ◽  
Transvenous Approach

Object The transvenous approach via the inferior petrosal sinus (IPS) is commonly used as the most appropriate for carotid-cavernous fistula (CCF) or cavernous sinus sampling. However, sometimes the IPS is not accessible because of anatomical problems and/or complications, therefore an alternative route is needed. In this paper, the authors present and discuss the utility of a transvenous approach to the cavernous sinus via the inferior petrooccipital vein. Methods Four patients, 3 with dural CCFs and the other with Cushing disease, in whom endovascular surgical attempts failed using a conventional venous approach via the IPS, underwent a transvenous approach to the cavernous sinus via the inferior petrooccipital vein (IPOV). One dural CCF case had only cortical venous drainage, the second CCF also mainly drained into the cortical vein with slight inflow into the superior ophthalmic vein and inferior ophthalmic vein, and the third demonstrated drainage into the superior and inferior ophthalmic veins and IPOV. Results In all cases, the cavernous sinus could be accessed successfully via this route and without complications. Conclusions The transvenous approach to the cavernous sinus via the IPOV should be considered as an alternative in cases when use of the IPS is precluded by an anatomical problem and there are no other suitable venous approach routes.

scholarly journals Spontaneous Closure of Cerebral Dural Arteriovenous Fistulas with Direct Cortical Venous Drainage

2009 ◽  
Vol 15 (3) ◽  
pp. 359-362 ◽  
Author(s):  
M. Voormolen ◽  
K. Geens ◽  
L. Van Den Hauwe ◽  
P.M. Parizel
Keyword(s):  
Contrast Medium ◽  
Venous Drainage ◽  
Spontaneous Closure ◽  
Fistula Closure ◽  
Selective Angiography ◽  
Cortical Vein ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

We describe two rare cases of spontaneous closure of cerebral dural arteriovenous fistulas (DAVFs) with a small nidus and draining directly in a single cortical vein with several ectasias. Eighteen previously published cases of spontaneous closure of cerebral DAVF comprised more benign fistula types. In literature, several explanations for DAVF occlusion have been proposed. We hypothesize that, in addition to the known causes, the specific contrast medium used during the diagnostic selective angiography might have played a role in the thrombosis and subsequent fistula closure.

scholarly journals Spontaneous resolution of direct carotid-cavernous fistulas: case series and literature review

2018 ◽  
Vol 25 (1) ◽  
pp. 71-89 ◽  
Author(s):  
Prasert Iampreechakul ◽  
Wuttipong Tirakotai ◽  
Adisak Tanpun ◽  
Yodkhwan Wattanasen ◽  
Punjama Lertbusayanukul ◽  
...  
Keyword(s):  
Literature Review ◽  
Case Series ◽  
Venous Drainage ◽  
Spontaneous Resolution ◽  
Spontaneous Closure ◽  
Low Flow ◽  
Spontaneous Thrombosis ◽  
Ocular Manifestations ◽  
Complete Obliteration ◽  
Carotid Cavernous Fistulas

Spontaneous regression of direct carotid-cavernous fistulas (CCFs) is extremely rare. Most of the patients with direct CCFs are usually treated using endovascular techniques. Spontaneous obliteration of the direct fistulas probably results from thrombosis of the venous drainage and/or cavernous sinus. We report spontaneous closure of nine direct CCFs in nine patients. From literature review, we found another 37 patients with 43 fistulas due to spontaneous obliteration of bilateral lesions in six cases. There was no spontaneous closure in large-sized fistula. The factors associated with spontaneous thrombosis of the fistulas may be low-flow and small-sized fistula, hypotension, severe ocular manifestations, dissections or spasm of carotid artery, and increased intracranial pressure. Spontaneous healing of direct traumatic CCFs should be confirmed with cerebral angiography. Conservative treatment of direct CCFs should be carefully restricted in patients with normal vision or minimal visual impairment, and the patients must be monitored closely for any changes in visual function. Prompt endovascular treatment for complete obliteration of the fistula should be performed in patients with rapidly progressive visual loss. Venous thrombosis can still effect vision and rerouting towards cortical veins remains a concern. Because spontaneous resolution cannot be reliably predicted, the fistula then should be treated rather than waiting for spontaneous thrombosis.

Surgical Treatment of Chronic Hand Ischemia: A Systematic Review and Case Series

2019 ◽  
Vol 24 (03) ◽  
pp. 359-370
Author(s):  
David L. Colen ◽  
Oded Ben-Amotz ◽  
Thibaudeau Stephanie ◽  
Arman Serebrakian ◽  
Martin J. Carney ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Surgical Intervention ◽  
Case Series ◽  
Ulnar Artery ◽  
Pharmacologic Therapy ◽  
Cold Intolerance ◽  
Algorithmic Approach ◽  
Surgical Interventions ◽  
Hand Ischemia

Background: Chronic hand ischemia refers to progressive, non-acute ischemic symptoms such as cold intolerance, rest pain, ulceration, tissue necrosis, and digit loss and poses a significant challenge in management. Conservative treatment begins with medical optimization and pharmacologic therapy, but when symptoms persist, surgical intervention may be required. Various operations exist to improve circulation including sympathectomy, arterial bypass, or venous arterialization. The purpose of this study is to systematically review published outcomes and present our experience with each surgical technique. Methods: A systematic review of literature regarding surgical treatment of chronic hand ischemia published between 1990 and 2016 was conducted using PRISMA guidelines. A retrospective-review of surgical interventions for chronic hand ischemia from 2010 to 2016 was then conducted. Primary outcomes included improvement in pain, wound-healing, and development of new ulcerations. Results: The review included 38 eight studies, showing all three techniques were effective in treating chronic hand ischemia. Sympathectomy had the lowest rate of new ulcerations (0.8%); bypass had the highest rate of healing existing ulcerations (89%). Arterialization was associated with consistent pain improvement pain (100%) but more complications (30.8%). Our series included 18 patients with 21 affected hands, 18 sympathectomies, 6 ulnar artery bypasses, and 1 arterialization. Most hands had improvement of wounds (89.5%) and pain (78.9%). No patients developed new ulcerations, but one required secondary amputation. Conclusions: When conservative measures fail to improve chronic hand ischemia, surgical intervention is an effective last line treatment. An algorithmic approach can determine the best operation for patients with chronic hand ischemia.

scholarly journals Case series of acute appendicitis association with SARS-CoV-2 infection

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charlsea Prichard ◽  
Matthew Canning ◽  
Kindra McWilliam-Ross ◽  
John Birbari ◽  
William Parker ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Retrospective Review ◽  
Surgical Intervention ◽  
Case Series ◽  
Single Institution ◽  
Chi Square ◽  
Surgical Interventions ◽  
Asymptomatic Patients ◽  
High Prevalence ◽  
Chi Square Analysis

Abstract Background Describe the indications for surgical interventions in asymptomatic patients with SARS-CoV-2. We are unaware of previous reports of an association between SARS-CoV-2 and acute appendicitis. Methods We performed a single institution retrospective review of SARS-CoV-2 pre-procedure testing and indications for surgical intervention. Statistical comparisons were performed using Chi Square analysis or two-tailed Student T test. Results We report a high prevalence of SARS-CoV-2 in both all testing and pre-procedure testing during the enrollment period. We observe a high prevalence of acute appendicitis among patients identified to be SARS-CoV-2 positive during pre-procedure testing and without recognized symptoms of COVID19. Conclusion We report a previously unrecognized association between SARS-CoV-2 and acute appendicitis.

Outcomes of Early Surgical versus Non-Surgical Management of Pediatric Hand Friction Injuries Caused by Treadmills

2021 ◽  
Author(s):  
Elika Ridelman ◽  
Paulette I Abbas ◽  
Beth A Angst ◽  
Justin D Klein ◽  
Christina M Shanti
Keyword(s):  
Surgical Intervention ◽  
Case Series ◽  
Complete Healing ◽  
Hospital Length Of Stay ◽  
Home Exercise ◽  
Recent Experience ◽  
Surgical Interventions ◽  
Additional Surgery ◽  
Hand Friction

Abstract Introduction Pediatric hand friction injuries caused by running treadmills are ever more prevalent due to the increasing presence of home exercise equipment. These and other related injuries have received recent attention in the media, leading to mass product recalls in some cases. These friction injuries are similar to deep thermal burns and these patients are usually cared for in the pediatric burn unit at our institution. We sought to describe our recent experience managing 22 patients with these injuries. Methods Patients were queried from our urban pediatric burn center database. After IRB approval, a retrospective chart review of all patients admitted for a treadmill-related hand injury over a 5-year period was performed. Data collected included patient demographics, initial treatment methods (surgical vs. non-operative), type of dressing used, hospital length of stay (LOS), and compliance with follow-up. We collected patient-centered outcomes included the time to healing and the need for subsequent surgical and/or non-surgical interventions to treat the sequelae of these injuries. Results Our center treated 22 hand friction injuries caused by treadmills over the 5-year period. Five patients (23%) underwent early surgical intervention (<30 days from injury), with a median time from injury of 7 days (IQR 1.75-13.5). This cohort required additional interventions to treat postoperative sequelae with 2 (40%) requiring additional surgery and 3 (60%) managed non-surgically. Of the 17 (77%) who were initially treatednon-operatively , 5 (29%) healed completely with dressing changes only and required no further treatment. Eleven (65%) had injury-related sequelae and were managed successfully with non-surgical interventions. Only 1 patient (6%) required scar modification by z-plasty. Average LOS was 14 hours and median number of weekly follow-up visits was 4 until complete healing. Conclusion Given the excellent outcomes observed in patients treated without acute surgical intervention in this case series, non-operative non-operative management appears to be feasible, safe and may reduce the need for operative intervention. These injuries, although small, are deep and require a prolonged period of dressing changes and aggressive therapy including post-healing time commitment to scar management in order to achieve best outcomes. Our study supports the need for increased community awareness of this type of injury.

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