Endovascular Therapy for Intracranial Dural Arteriovenous Fistulas

Abstract

A retrospective study was conducted on 17 consecutive patients with DAVF admitted to Monash Medical Centre over 12 years. 15 patients, 82.4%, were treated by endovascular means with the intention to obliterate the fistula. Three of these patients also had surgery following embolisation. Angiographic cure was achieved when we have successfully embolised both the arterial and the venous side whether by penetration of liquid adhesive or packing with coils. Our cure rate of 60% (95% CI: 37–83%) compare favourably with published results of 50 to 70%. Our clinical complication rate is 1/15, 6%; and technical complication is1 from 32 embolisation sessions, 3.1%. Endovascular therapy is effective in achieving a durable angiographic and clinical cure in the treatment of intracranial DAVF. Both arterial and venous side need to be occluded.

Keywords

dural arteriovenous fistulas embolisation endovascular therapy N-butyl cyanoacrylate DAVF

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References

Hamada

Goto

Inoue

: Histopathological aspects of dural arteriovenous fistulas in the transverse-sigmoid sinus region in nine patients. Neurosurgery 40: 452–6, 1997.

Chaloupka

: Endovascular Therapy for Dural Arteriovenous Fistulas. In: Marks

: Endovascular and Percutaneous Therapy of the Brain and Spine. Lippincott Williams & Wilkins, Philadelphia 2002: 277–315.

Sundt

Piepgras

: The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg 59: 32–39, 1983.

ApSimon

Ives

Khangure

: Cranial dural arteriovenous malformation and fistula. Radiological diagnosis and management. Review of thirty four patients. Australas Radiol 37: 2–25, 1993.

Fransen

Mathurin

Pierre

: Interest and necessity of combined neuroradiological and neurosurgical treatment in some cases of dural arterio-venous fistulae. Acta Neurochir 121: 26–33, 1993.

Pelz

Lownie

Fox

: Intracranial dural arteriovenous fistulae with pial venous drainage: Combined endovascular-neurosurgical therapy. Can J Neurol Sci 24: 210–8, 1997.

Lin

Elwood

Fraser

: Venous ligation of dural arteriovenous fistulae. Br J Neurosurg 17: 239–43, 2003.

Kattner

Roth

Giannotta

: Cranial base approaches for the surgical treatment of aggressive posterior fossa dural arteriovenous fistulae with leptomeningeal drainage: Report of four technical cases. Neurosurgery 50: 1156–60, 2002.

O'Leary

Hodgson

Coley

: Intracranial dural arteriovenous malformations: Results of stereotactic radiosurgery in 17 patients. Clin Oncol (R Coll Radiol) 14: 97–102, 2002.

10.

Bertalanffy

Dietrich

Kitz

: Treatment of dural arteriovenous fistulae (dAVF's) at the superior sagittal sinus (SSS) using embolisation combined with micro- or radiosurgery. Minim Invasive Neurosurg 44: 205–10, 2001.

11.

Murphy

Gailloud

Venbrux

: Endovascular treatment of a grade IV transverse sinus dural arteriovenousfistula by sinus recanalization, angioplasty, and stent placement: Technical case report. Neurosurgery 46: 497–500, 2000.

12.

Warakaulle

Aviv

Niemann

: Embolisation of spinal dural arteriovenous fistulae with Onyx. Neuroradiology 45: 110–2, 2003.

13.

Cognard

Gobin

Pierot

: Cerebral dural arteriovenous fistulas: Clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194: 671–80, 1995.

14.

Halback

Higashida

Hieshima

: Endovascular Therapy of Dural Fistulas. In: Vinuela

Halback

Dion

: Interventional Neuroradiology: Endovascular Therapy of the Central Nervous System, Raven Press, New York 1992: 29–50.

15.

Berenstetin

: Dural arteriovenous malformations. Seventh annual Stowin medial conference abstracts. Am J Neuroradiol 11: 221–222.

16.

Picard

Bracard

Mallet

: Spontaneous dural arteriovenous fistulas. Seminar Intervent Radiol 4: 219–240, 1987.