scholarly journals Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome

2013 ◽  
Vol 34 (5) ◽  
pp. E15 ◽  
Author(s):  
David J. Daniels ◽  
Ananth K. Vellimana ◽  
Gregory J. Zipfel ◽  
Giuseppe Lanzino
Keyword(s):  
Clinical Features ◽  
Intracranial Hemorrhage ◽  
Case Series ◽  
Venous Drainage ◽  
Sudden Onset ◽  
Residual Symptoms ◽  
Arteriovenous Fistulas ◽  
Common Location ◽  
Dural Arteriovenous Fistulas

Object In this paper the authors' goal was to review the clinical features and outcome of patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with hemorrhage. Methods A retrospective study of 28 patients with DAVFs who presented with intracranial hemorrhage to 2 separate institutions was performed. The information reviewed included clinical presentation, location and size of hemorrhage, angiographic features, treatment, and clinical and radiologically documented outcomes. Clinical and radiological follow-up were available in 27 of 28 patients (mean follow-up 17 months). Results The vast majority of patients were male (86%), and the most common presenting symptom was sudden-onset headache. All DAVFs had cortical venous drainage, and about one-third were associated with a venous varix. The most common location was tentorial (75%). Treatment ranged from endovascular (71%), surgical (43%), Gamma Knife surgery (4%), or a combination of modalities. The majority of fistulas (75%) were completely obliterated, and most patients experienced excellent clinical outcome (71%, modified Rankin Scale score of 0 or 1). There were no complications in this series. Conclusions Case series, including the current one, suggest that the vast majority of patients who present with intracranial hemorrhage from a DAVF are male. The most common location for DAVFs presenting with hemorrhage is tentorial. Excellent outcomes are achieved with individualized treatment, which includes various therapeutic strategies alone or in combination. Despite the hemorrhagic presentation, almost two-thirds of patients experience a full recovery with no or minimal residual symptoms.

scholarly journals Intracranial Hemorrhage from Dural Arteriovenous Fistulas: What Can We Find with CT Angiography?

Tomography ◽  
2021 ◽  
Vol 7 (4) ◽  
pp. 804-814
Author(s):  
Alberto Negro ◽  
Francesco Somma ◽  
Valeria Piscitelli ◽  
Giuseppe Maria Ernesto La Tessa ◽  
Carmine Sicignano ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Intracranial Hemorrhage ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Diagnostic Technique ◽  
Signs And Symptoms ◽  
Sudden Onset ◽  
Arteriovenous Fistulas ◽  
Common Location ◽  
Dural Arteriovenous Fistulas

(1) Background: Dural arteriovenous fistulas (DAVF) represent a rare acquired intracranial vascular malformation, with a variety of clinical signs and symptoms, which make their diagnosis difficult. Intracranial hemorrhage is one of the most serious clinical manifestations. In this paper the authors’ goal was to verify the accuracy and utility of contrast-enhanced brain CT angiography (CTA) for the identification and the characterization of dural arteriovenous fistulas (DAVFs) in patients who presented with brain hemorrhage compared to 3D digital subtraction angiography (3D DSA); (2) a retrospective study of 26 patients with DAVFs who presented with intracranial hemorrhage to our institution was performed. The information reviewed included clinical presentation, location and size of hemorrhage, brain CTA and 3D DSA findings; (3) results: 61% (16/26) of DAVFs were identified by CTA. The vast majority of patients were male (69%, 18/26) and the most common presenting symptom was sudden onset headache. All DAVFs had cortical venous drainage and about one-third were associated with a venous varix. The most common location was tentorial (73%, 19/26); (4) conclusions: CTA can represent a valid alternative diagnostic method to 3D DSA for the study of DAVF in the initial and preliminary diagnostic approach, especially in emergency situations. In fact, it represents a fast, inexpensive, non-invasive and above all, easily accessible and available diagnostic technique, unlike DSA or MRI, allowing to provide information necessary for the identification, classification and treatment planning of DAVFs.

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.

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

2002 ◽  
Vol 97 (4) ◽  
pp. 767-770 ◽  
Author(s):  
Junichiro Satomi ◽  
J. MARC C. van Dijk ◽  
Karel G. Terbrugge ◽  
Robert A. Willinsky ◽  
M. Christopher Wallace
Keyword(s):  
Conservative Management ◽  
Venous Drainage ◽  
Initial Assessment ◽  
Benign Condition ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Tolerable Level ◽  
Fine Print

Object. Cranial dural arteriovenous fistulas (DAVFs) can be classified into benign or aggressive, based on their patterns of venous drainage. A benign condition requires the absence of cortical venous drainage (CVD). The clinical and angiographic features of a consecutive single-center group of 117 patients harboring benign cranial DAVFs were evaluated over time to validate the behavior and appropriate management of these lesions. Methods. At the initial assessment four patients were asymptomatic. Two infants presented with congestive heart failure. All other patients presented with other benign symptoms: chronic headache, bruit, or orbital phenomena. Observational management was instituted in 73 patients (62%). Intolerable bruit or ophthalmological sequelae were deemed indications for palliative embolization in 43 patients and surgical treatment in one patient. A median follow-up period of 27.9 months (range 1 month—17.5 years) was available in 112 patients (95.7%), among whom repeated angiography was performed in 50. Overall, observational and palliative management resulted in a benign and tolerable level of disease in 110 (98.2%) of 112 cases. In two cases managed conservatively CVD developed. In both of these cases the conversion from benign to aggressive DAVF was associated with spontaneous progressive thrombosis of venous outlets. Conclusions. The disease course of a cranial DAVF without CVD is indeed benign, obviating the need for a cure of these lesions. Symptoms are well tolerated with either observation or palliative treatment. After a long-term follow-up review of 68 patients, this conservative management resulted in a benign and tolerable level of disease in 98.5% of cases. It is noteworthy, however, that a benign DAVF carries a 2% risk of developing CVD, mandating close clinical follow-up review in such cases and renewed radiological evaluation in response to any deterioration in the patient's condition.

Borden-Shucart Type I dural arteriovenous fistulas: clinical course including risk of conversion to higher-grade fistulas

2012 ◽  
Vol 117 (3) ◽  
pp. 539-545 ◽  
Author(s):  
Manish N. Shah ◽  
James A. Botros ◽  
Thomas K. Pilgram ◽  
Christopher J. Moran ◽  
DeWitte T. Cross ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Clinical Course ◽  
Retrospective Chart Review ◽  
Annual Rate ◽  
Neurological Deficits ◽  
Type I ◽  
Arteriovenous Fistulas ◽  
Presenting Symptoms ◽  
Dural Arteriovenous Fistulas

Object The goal of this study was to determine the clinical course of Borden-Shucart Type I cranial dural arteriovenous fistulas (DAVFs) and to calculate the annual rate of conversion of these lesions to more aggressive fistulas that have cortical venous drainage (CVD). Methods A retrospective chart review was conducted of all patients harboring DAVFs who were seen at the authors' institution between 1997 and 2009. Twenty-three patients with Type I DAVFs who had available clinical follow-up were identified. Angiographic and clinical data from these patients were reviewed. Neurological outcome and status of presenting symptoms were assessed during long-term follow-up. Results Of the 23 patients, 13 underwent endovascular treatment for intolerable tinnitus or ophthalmological symptoms, and 10 did not undergo treatment. Three untreated patients died of unrelated causes. In those who were treated, complete DAVF obliteration was achieved in 4 patients, and palliative reduction in DAVF flow was achieved in 9 patients. Of the 19 patients without radiographic cure, no patient developed intracranial hemorrhage or nonhemorrhagic neurological deficits (NHNDs), and no patient died of DAVF-related causes over a mean follow-up of 5.6 years. One patient experienced a spontaneous, asymptomatic obliteration of a partially treated DAVF in late follow-up, and 2 patients experienced a symptomatic conversion of their DAVF to a higher-grade fistula with CVD in late follow-up. The annual rate of conversion to a higher-grade DAVF based on Kaplan-Meier cumulative event-free survival analysis was 1.0%. The annual rate of intracranial hemorrhage, NHND, and DAVF-related death was 0.0%. Conclusions A small number of Type I DAVFs will convert to more aggressive DAVFs with CVD over time. This conversion to a higher-grade DAVF is typically heralded by a change in patient symptoms. Follow-up vascular imaging is important, particularly in the setting of recurrent or new symptoms.

Concomitant conus medullaris arteriovenous shunts and sacral dural arteriovenous fistulas: pathophysiological links related to the venous drainage of the lesions in a series of five cases

2018 ◽  
Vol 10 (6) ◽  
pp. 586-592 ◽  
Author(s):  
Andrea Rosi ◽  
Arturo Consoli ◽  
Stéphanie Condette-Auliac ◽  
Oguzhan Coskun ◽  
Federico Di Maria ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Young Patients ◽  
Case Series ◽  
Venous Drainage ◽  
Conus Medullaris ◽  
Venous Hypertension ◽  
Arteriovenous Fistulas ◽  
Congenital Origin ◽  
Arteriovenous Shunts ◽  
Dural Arteriovenous Fistulas

BackgroundSpinal cord arteriovenous shunts (scAVSs) are a group of lesions located in the spinal cord itself or in the surrounding structures. The most common scAVSs are spinal dural arteriovenous fistulas (sDAVFs), which are acquired lesions. The pathogenesis of sDAVFs involves thrombosis and venous hypertension as trigger factors. Intradural scAVSs such as spinal cord arteriovenous nidus type malformations (AVMs) and pial arteriovenous fistulas are less common than sDAVFs and are considered to have a so-called ‘congenital’ origin. The association between different concomitant scAVSs is very rare and the association of sDAVFs with intradural scAVSs has been described in only a few case reports.MethodsWe describe a case series of five patients presenting with a conus medullaris AVS associated with a lower lumbar or sacral DAVF.ResultsThree of our patients were <30 years old at presentation. In four of these five cases the intradural scAVS drained caudally, engorging the epidural plexus in the same location as the sDAVF. In only one case, who presented with thrombosis of the drainage of the main compartment of a conus medullaris pial AVF, was the location of the DAVF opposite to the location of the residual drainage.ConclusionWe discuss the pathophysiological link between scAVS and sDAVF on the basis of the rarity of the DAVF, the uncommon association between scAVS and sDAVF, the presence of sDAVF in young patients, and the venous hypertension created by the venous drainage towards the sacral area responsible for angiogenesis creating the dural shunt.

Stereotactic radiosurgery for cerebral dural arteriovenous fistulas

2012 ◽  
Vol 32 (5) ◽  
pp. E18 ◽  
Author(s):  
Bradley A. Gross ◽  
Alexander E. Ropper ◽  
A. John Popp ◽  
Rose Du
Keyword(s):  
Stereotactic Radiosurgery ◽  
Venous Drainage ◽  
Review Of The Literature ◽  
Obliteration Rate ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Relative Paucity ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage

Object Given the feasibility of curative surgical and endovascular therapy for cerebral dural arteriovenous fistulas (DAVFs), there is a relative paucity of radiosurgical series for these lesions as compared with their arteriovenous malformation counterparts. Methods The authors reviewed records of 56 patients with 70 cerebral DAVFs treated at their institution over the past 6 years. Ten DAVFs (14%) in 9 patients were treated with stereotactic radiosurgery (SRS), with follow-up obtained for 8 patients with 9 DAVFs. They combined their results with those obtained from a comprehensive review of the literature, focusing on obliteration rates, post-SRS hemorrhage rates, and other complications. Results In the authors' group of 9 DAVFs, angiographic obliteration was seen in 8 cases (89%), and no post-SRS hemorrhage or complications were observed after a mean follow-up of 2.9 years. Combining the results in these cases with data obtained from their review of the literature, they found 558 DAVFs treated with SRS across 14 series. The overall obliteration rate was 71%; transient worsening occurred in 9.1% of patients, permanent worsening in 2.4% (including 1 death, 0.2% of cases), and post-SRS hemorrhage occurred in 1.6% of cases (4.8% of those with cortical venous drainage [CVD]). The obliteration rate for cavernous DAVFs was 84%, whereas the rates for transversesigmoid and for tentorial DAVFs were 58% and 59%, respectively (adjusted p values, pcav,TS = 1.98 × 10−4, pcav,tent = 0.032). Obliteration rates were greater for DAVFs without CVD (80%, compared with 60% for those with CVD, p = 7.59 × 10−4). Both transient worsening and permanent worsening were less common in patients without CVD than in those with CVD (3.4% vs 7.3% for transient worsening and 0.9% vs 2.4% for permanent worsening). Conclusions Stereotactic radiosurgery with or without adjunctive embolization is an effective therapy for DAVFs that are not amenable to surgical or endovascular monotherapy. It is best suited for lesions without CVD and for cavernous DAVFs.

scholarly journals Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

2009 ◽  
Vol 36 (2) ◽  
pp. 168-175 ◽  
Author(s):  
Jason Chew ◽  
Alain Weill ◽  
François Guilbert ◽  
Jean Raymond ◽  
Marie-Eve Audet ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Venous Drainage ◽  
Occipital Artery ◽  
Endovascular Management ◽  
Arteriovenous Fistulas ◽  
Arterial Embolisation ◽  
Dural Arteriovenous Fistulas ◽  
Cortical Venous Drainage ◽  
Onyx Embolisation

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.

scholarly journals Microsurgical treatment of intracranial dural arteriovenous fistulas. Case series and review of the literature

2020 ◽  
Vol 31 (1) ◽  
pp. 34-41
Author(s):  
D.V. Shchehlov ◽  
M.S. Gudym ◽  
O.E. Svyrydiuk ◽  
M.B. Vyval
Keyword(s):  
Clinical Symptoms ◽  
Case Series ◽  
Venous Drainage ◽  
Middle Cranial Fossa ◽  
Transverse Sinus ◽  
Endovascular Embolization ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Surgical Methods ◽  
Dural Arteriovenous Fistulas

Objective ‒ to evaluate peculiarities and results of microsurgical treatment of intracranial dural arteriovenous fistulas (DAVF).Materials and methods. A retrospective analysis of microsurgical treatment of 7 patients with DAVF (4 (57. 1%) women and 3 (42.9 %) men, average age ‒ 43.4 years), who were hospitalized and surgically treated at the SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» from 2016 to 2020, was made. DAVF was drained into the superior sugittal sinus in 4 (57.1 %) patients, transverse and sigmoid sinuses in 2 (28.6 %) cases, in the middle cranial fossa in 1 (14.3 %). According to the Cognard classification there were 3 (42.9 %) DAVFs belong to type IIb, 2 (28.6 %) ‒ to type IIa + b, 1 (14.3 %) DAVF ‒ to type II, 1 (14.3 %) DAVF ‒ to type IV.Results. In 3 (42.9 %) patients were primarily treated with endovascular method. Follow up studies revealed a recurrence of the disease, and microsurgical disconnection was performed. In 4 (57.1 %) cases, endovascular access to superficial DAVF was risky due to anatomical features, and microsurgery was preferred. In all patients, surgical treatment aimed the disconnecting of the shunt. In 1 (14.3 %) case of DAVF the transverse sinus was ligated. In all cases angiographic confirmation of the DAVFs exclusion was performed. In the postoperative period, there was no evidence of an increasing of clinical symptoms. All patients with pulsatile tinnitus and headache noted their regression after surgery.Conclusions. Considering the efficacy of modern endovascular techniques, microsurgery of DAVF has been indicated in cases where endovascular embolization has proven to be no-n-efficient or technically impossible. Among surgical methods of DAVF treatment, there are disconnection of the meningeal arteries directly at the site of the fistula, resection of the abnormal dura mater with feeding vessels, ligation and intersections of the injured venous sinus, skeletonization of the sinus with the feeding dural vessels. Treatment should be performed in all cases of DAVF with cortical venous drainage and progressive symptoms of the disease. The choice of optimal treatment should be made in a multidisciplinary manner, and all possible methods should be taken into consideration.

scholarly journals Intraarterial and Intravenous Treatment of Transverse/Sigmoid Sinus Dural Arteriovenous Fistulas

2009 ◽  
Vol 15 (3) ◽  
pp. 291-300 ◽  
Author(s):  
X. Lv ◽  
C. Jiang ◽  
Y. Li ◽  
X. Yang ◽  
Z. Wu
Keyword(s):  
Treatment Strategy ◽  
Arterial Embolization ◽  
Sigmoid Sinus ◽  
Embolic Agent ◽  
Type I ◽  
Arteriovenous Fistulas ◽  
Common Location ◽  
Additional Surgery ◽  
Dural Arteriovenous Fistulas

Transverse/sigmoid sinus (TS) is the most common location for cerebral dural arteriovenous fistulas (DAVFs). Most of them are cured by venous embolization or a combination of arterial embolization and surgery/radiosurgery. Our goal was to reconsider the endovascular treatment strategy of TSDAVFs according to the new possibilities of arterial embolization using Onyx-18. Nineteen patients with TSDAVFs were included in a prospective study between 2004 and 2007. Three of them had type I, four had type IIa, six had type IIa+b, three had type III, and three had type IV fistulas. Three presented with subarachnoid hemorrhage. The approach routes, angiographic results, complications, and clinical outcome were assessed. The mean clinical follow-up period was 32.5 months. In one patient, the DAVF had been obliterated spontaneously at ten month follow-up. Complete angiographic cure was obtained in nine cases with one case of progressive thrombosis. Of these ten cures were achieved after a single procedure in seven out of ten patients who had not been embolized previously. Three patients were cured with sinus packing with prior arterial embolization. Among these 19 patients, 15 underwent follow-up angiography which confirmed the complete cure. Partial occlusion was obtained in nine patients, one was cured after additional surgery, and one underwent radiosurgery. Hallucination occurred in one completely cured patient on day one. Based on this experience, we believe that intraarterial Onyx may be the primary treatment of choice for patients with TSDAVFs. The applicability of this new embolic agent indicates the need for reconsideration of the treatment strategy for such fistulas.

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