Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Transarterial Embolization of Intracranial Arteriovenous Fistulas with Large Venous Pouches in the Form of Venous Outlet Ectasia and Large Venous Varix or Aneurysm : Two Centers Experience

  • Deniwar, Mohamed Adel (Department of Neurosurgery, Mansoura University Hospitals, Mansoura University) ;
  • Ahmad, Saima (Department of Diagnostic and Interventional Neuroradiology, Lahore General Hospital, Post Graduate Medical Institute, Ameer-ud-Din Medical College) ;
  • Eldin, Ashraf Ezz (Department of Neurosurgery, Mansoura University Hospitals, Mansoura University)
  • Received : 2021.05.12
  • Accepted : 2021.07.14
  • Published : 2022.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : There are different types of cerebral vascular malformations. Pial arteriovenous fistulas (PAVFs) and dural arteriovenous fistulas (DAVFs) are two entities; they consist of one or more arterial connections to a single venous outlet without a true intervening nidus. The high turbulent flow of PAVFs and aggressive DAVFs with cortical venous reflux can result in venous outflow varix and aneurysmal dilatation. They pose a significant challenge to transvenous embolization (TVE), stereotactic radiosurgery, and surgical treatment. We aim to share our centers' experience with the transarterial embolization (TAE) for arteriovenous fistulas (AVFs) with large venous pouches and to report the outcome. Methods : The authors' two institutions' databases were retrospectively reviewed from February 2017 to February 2021. All patients with intracranial high flow PAVFs and aggressive DAVFs with venous outlet ectasia and large venous varix and were treated by TAE were included. Results : Fifteen patients harboring 11 DAVFs and four PAVFs met our inclusion criteria. All patients underwent TAE in 17 sessions. Complete angiographic obliteration was achieved after 14 sessions in 12 patients (80%). Four patients (25%) had residual after one TAE session. Technical failure was documented in one patient (6.7%). Fourteen patients (93.3%) had favorable functional outcome (modified Rankin score 0-2). Conclusions : TAE for high flow or aggressive intracranial AVFs is a safe and considerable treatment option, especially for those associated with large venous pouches that are challenging and relatively high-risk for TVE.

Keywords

References

  1. Alturki AY, Enriquez-Marulanda A, Schmalz P, Ogilvy CS, Thomas AJ : Transarterial onyx embolization of bilateral transverse-sigmoid dural arteriovenous malformation with transvenous balloon assist-initial U.S. experience with copernic RC venous remodeling balloon. World Neurosurg 109 : 398-402, 2018 https://doi.org/10.1016/j.wneu.2017.10.083
  2. Baharvahdat H, Ooi YC, Kim WJ, Mowla A, Coon AL, Colby GP : Updates in the management of cranial dural arteriovenous fistula. Stroke Vasc Neurol 5 : 50-58, 2019 https://doi.org/10.1136/svn-2019-000269
  3. Bhattacharya JJ, Thammaroj J : Vein of galen malformations. J Neurol Neurosurg Psychiatry 74 Suppl 1(Suppl 1) : i42-i44, 2003 https://doi.org/10.1136/jnnp.74.suppl_1.i42
  4. Biondi A, Casasco A, Houdart E, Gioino C, Sourour N, Vivas E, et al. : Evolution of angiographic signs of venous hypertension and clinical signs of intracranial hypertension in intracranial dural arteriovenous fistulas. J Neuroradiol 26 : 49-58, 1999
  5. Borden JA, Wu JK, Shucart WA : A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82 : 166-179, 1995 https://doi.org/10.3171/jns.1995.82.2.0166
  6. Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, et al. : Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194 : 671-680, 1995 https://doi.org/10.1148/radiology.194.3.7862961
  7. Cooke D, Tatum J, Farid H, Dowd C, Higashida R, Halbach V : Transvenous embolization of a pediatric pial arteriovenous fistula. J Neurointerv Surg 4 : e14, 2012 https://doi.org/10.1136/neurintsurg-2011-010028
  8. Gandhi D, Chen J, Pearl M, Huang J, Gemmete JJ, Kathuria S : Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. AJNR Am J Neuroradiol 33 : 1007-1013, 2012 https://doi.org/10.3174/ajnr.A2798
  9. Goel A, Jain S, Shah A, Rai S, Gore S, Dharurkar P : Pial arteriovenous fistula: a brief review and report of 14 surgically treated cases. World Neurosurg 110 : e873-e881, 2018 https://doi.org/10.1016/j.wneu.2017.11.121
  10. Gonzalez LF, Chalouhi N, Jabbour P, Teufack S, Albuquerque FC, Spetzler RF : Rapid and progressive venous thrombosis after occlusion of high-flow arteriovenous fistula. World Neurosurg 80 : e359-e365, 2013 https://doi.org/10.1016/j.wneu.2012.10.043
  11. Hetts SW, Keenan K, Fullerton HJ, Young WL, English JD, Gupta N, et al. : Pediatric intracranial nongalenic pial arteriovenous fistulas: clinical features, angioarchitecture, and outcomes. AJNR Am J Neuroradiol 33 : 1710-1719, 2012 https://doi.org/10.3174/ajnr.A3194
  12. Hoh BL, Putman CM, Budzik RF, Ogilvy CS : Surgical and endovascular flow disconnection of intracranial pial single-channel arteriovenous fistulae. Neurosurgery 49 : 1351-1363; discussion 1363-1364, 2001 https://doi.org/10.1097/00006123-200112000-00011
  13. Jabbour P, Tjoumakaris S, Chalouhi N, Randazzo C, Gonzalez LF, Dumont A, et al. : Endovascular treatment of cerebral dural and pial arteriovenous fistulas. Neuroimaging Clin N Am 23 : 625-636, 2013 https://doi.org/10.1016/j.nic.2013.03.010
  14. Kirsch M, Henkes H, Liebig T, Weber W, Esser J, Golik S, et al. : Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients. Neuroradiology 48 : 486-490, 2006 https://doi.org/10.1007/s00234-006-0089-9
  15. Koebbe CJ, Singhal D, Sheehan J, Flickinger JC, Horowitz M, Kondziolka D, et al. : Radiosurgery for dural arteriovenous fistulas. Surg Neurol 64 : 392-398; discussion 398-399, 2005 https://doi.org/10.1016/j.surneu.2004.12.026
  16. Kwon BJ, Han MH, Kang HS, Chang KH : MR imaging findings of intracranial dural arteriovenous fistulas: relations with venous drainage patterns. AJNR Am J Neuroradiol 26 : 2500-2507, 2005
  17. Lasjaunias P, Manelfe C, Chiu M : Angiographic architecture of intracranial vascular malformations and fistulas--pretherapeutic aspects. Neurosurg Rev 9 : 253-263, 1986 https://doi.org/10.1007/BF01743632
  18. Lekkhong E, Pongpech S, Ter Brugge K, Jiarakongmun P, Willinsky R, Geibprasert S, et al. : Transvenous embolization of intracranial dural arteriovenous shunts through occluded venous segments: experience in 51 Patients. AJNR Am J Neuroradiol 32 : 1738-1744, 2011 https://doi.org/10.3174/ajnr.A2566
  19. Liu CA, Chen HC, Luo CB, Guo WY, Mu-Huo Teng M, Chen HH, et al. : Dural sinus malformation with arteriovenous fistulae in a newborn: positive outcome following endovascular management. J Chin Med Assoc 75 : 43-46, 2012 https://doi.org/10.1016/j.jcma.2011.10.007
  20. Lv X, Chen X, Ge H, He H, Jiang C, Li Y : Adjunct to embolize the high-flow fistula part of arteriovenous malformation using a double-lumen balloon catheter. World Neurosurg 96 : 370-374, 2016 https://doi.org/10.1016/j.wneu.2016.09.006
  21. Maejima R, Ohshima T, Miyachi S, Matsuo N, Kawaguchi R, Takayasu M : Neonatal intracranial pial arteriovenous fistula treated with endovascular embolization: a case report. World Neurosurg 118 : 261-264, 2018 https://doi.org/10.1016/j.wneu.2018.07.114
  22. Mohammed N, Hung YC, Xu Z, Starke RM, Kano H, Lee J, et al. : A propensity score-matched cohort analysis of outcomes after stereotactic radiosurgery in older versus younger patients with dural arteriovenous fistula: an international multicenter study. World Neurosurg 125 : e1114-e1124, 2019 https://doi.org/10.1016/j.wneu.2019.01.253
  23. Oh SH, Choi JH, Kim BS, Lee KS, Shin YS : Treatment outcomes according to various treatment modalities for intracranial dural arteriovenous fistulas in the onyx era: a 10-year single-center experience. World Neurosurg 126 : e825-e834, 2019 https://doi.org/10.1016/j.wneu.2019.02.173
  24. Pan L, Wen JP, Ma LT : Differences between CS-DAVF and TCCF--to reveal and redefine CS-DAVF. Chin Neurosurg J 4 : 26, 2018 https://doi.org/10.1186/s41016-018-0121-z
  25. Qureshi AM, Bhatia K, Kostynskyy A, Krings T : Clinical and angioarchitectural features of ruptured dural arteriovenous fistulas. World Neurosurg 147 : e476-e481, 2021 https://doi.org/10.1016/j.wneu.2020.12.091
  26. Vinuela F, Drake CG, Fox AJ, Pelz DM : Giant intracranial varices secondary to high-flow arteriovenous fistulae. J Neurosurg 66 : 198-203, 1987 https://doi.org/10.3171/jns.1987.66.2.0198
  27. Yang WH, Lu MS, Cheng YK, Wang TC : Pial arteriovenous fistula: a review of literature. Br J Neurosurg 25 : 580-585, 2011 https://doi.org/10.3109/02688697.2011.566382
  28. Yuki I, Kim RH, Duckwiler G, Jahan R, Tateshima S, Gonzalez N, et al. : Treatment of brain arteriovenous malformations with high-flow arteriovenous fistulas: risk and complications associated with endovascular embolization in multimodality treatment. Clinical article. J Neurosurg 113 : 715-722, 2010 https://doi.org/10.3171/2009.9.JNS081588