Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-25T18:30:31.606Z Has data issue: false hasContentIssue false
  • English
  • Français

Intracranial Dural Arteriovenous Fistulae with Pial Venous Drainage: Combined Endovascular - Neurosurgical Therapy

Published online by Cambridge University Press:  18 September 2015

Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Intracranial dural arteriovenous fistula with pial venous drainage may present with hemorrhage or focal neurologic deficit and may be difficult to treat. We wish to summarize the therapeutic approaches to these potentially dangerous lesions and to demonstrate how endovascular and neurosurgical therapies may have complimentary roles in their management.

Methods:

The clinical and radiological records of all patients who presented to our institution with intracranial dural arteriovenous fistula over the last 5 years were reviewed. In those cases demonstrating pial venous drainage, details of presentation, imaging features, endovascular and surgical therapy and outcome were analyzed.

Results:

We identified 13 patients with these lesions, 7 of whom presented with intracranial hemorrhage. Six patients were treated with embolization alone. Angiographic cure was achieved in 4. There was one complication in this group, a subarachnoid hemorrhage following glue injection. Four patients were treated with embolization followed by surgical occlusion of the pial venous drainage. Angiographic cure was achieved in all 4. There was one complication in this group, a facial nerve palsy following glue injection. Three patients were treated by surgery alone, with no complications and complete cure in all.

Conclusion:

Endovascular therapy of intracranial dural arteriovenous fistula may be curative but is often complex and carries definite risks. Neurosurgical ligation of pial draining veins, with pre-operative embolization when safe, may be a relatively more controlled method to achieve complete cure.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 24 , Issue 3 , August 1997 , pp. 210 - 218
Copyright
Copyright © Canadian Neurological Sciences Federation 1997

References

REFERENCES

1.Houser, OW, Baker, HL, Rhoton, AL, Okazaki, H. Intracranial dural arteriovenous malformations. Radiology 1972; 105: 55–64.Google Scholar
2.Vinuela, F, Fox, AJ, Pelz, DM, Drake, CG. Unusual clinical manifestations of dural arteriovenous malformations. J Neurosurg 1986; 64: 554–558.Google Scholar
3.Brown, RD, Wieber, DO, Nichols, DA. Intracranial dural arteriovenous fistulae: angiographic predictors of intrancranial hemorrhage and clinical outcome in non-surgical patients. J Neurosurg 1994;81:531–538.Google Scholar
4.Cognard, C, Gobin, YP, Pierot, L, et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995; 194: 671–680.Google Scholar
5.Borden, JA, Wu, JK, Shucart, WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 1995; 82: 166–179.CrossRefGoogle ScholarPubMed
6.Mullan, S. Reflections upon the nature and management of intracranial and intraspinal vascular malformations and fistulae. J Neurosurg 1994; 80: 606–616.Google Scholar
7.Lownie, SP. Intracranial dural arteriovenous fistulas: endovascular therapy. Neurosurg Clin North Am 1994; 5: 449–458.Google Scholar
8.Halbach, VV, Hieshema, GB, Higashida, RT, Dowd, CF. Endovascular therapy of dural fistulas. In: Vinuela, F, Halbach, VV, Dion, JE, eds. Interventional Neuroradiology: Endovascular Therapy of the Central Nervous System. New York: Raven, 1992: 29–50.Google Scholar
9.Thompson, BG, Doppman, JL, Oldfield, EH. Treatment of cranial dural arteriovenous fistulae by interruption of leptomeningeal venous drainage. J Neurosurg 1994; 80: 617–623.Google Scholar
10.Grisoli, F, Vincentelli, F, Fuch, S, et al. Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space. Report of 4 cases. J Neurosurg 1984; 60: 1059–1066.CrossRefGoogle Scholar
11.Urtasun, F, Biondi, A, Casasco, A, et al. Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization. Radiology 1996; 199: 209–217.Google Scholar
12.Halbach, V, Higishida, RT, Hieshema, GB, Mehringer, CM, Hardin, CW. Transvenous embolization of dural fistulas involving the transverse and sigmoid sinuses. Am J Neuroradiol 1989; 10: 385–392.Google Scholar
13.Halbach, VV, Higashida, RT, Hieshema, GB, Hardin, CW, Pribram, H. Tranvenous embolization of dural fistulas involving the cavernous sinus. Am J Neuroradiol 1989; 10: 377–382.Google Scholar
14.Sundt, TM, Piepgras, DG. The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg 1983; 59: 32–39.CrossRefGoogle ScholarPubMed
15.Monsein, LH, Debrun, GM, Miller, NR, Nauta, HJ, Chazaly, JR. Treatment of dural carotid cavernous fistulas via the superior ophthalmic vein. Am J Neuroradiol 1991; 12: 435–439.Google Scholar
16.Lewis, AI, Thomsick, TA, Tew, JM. Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery. J Neurosurg 1994; 81:851–859.Google Scholar
17.Barnwell, SL, Halbach, VV, Higashida, RT, Hieshema, GB, Wilson, CB. Complex dural arteriovenous fistulas. Results of combined endovascular and neurosurgical treatment in 16 patients. J Neurosurg 1989; 71: 352–358.Google Scholar
18.Oldfield, EH, DiChiro, G, Quindlen, EA, et al. Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula. J Neurosurg 1983; 59: 1019–1030.CrossRefGoogle ScholarPubMed
19.Lasjaunias, P, Chiu, M, Ter Brugge, K, et al. Neurologic manifestations of intracranial dural arteriovenous malformations. J Neurosurg 1986; 64: 724–730.CrossRefGoogle Scholar
20.Awad, IA, Little, JR, Akrawi, WP, Ahl, J. Intracranial dural arteriovenous malformations: factors pre-disposing to an aggressive neurological course. J Neurosurg 1990; 72: 839–850.Google Scholar