Anterior Cranial Fossa Dural Arteriovenous Fistula Research Articles

Posterior short ciliary arteries ischemia following embolization of anterior ethmoid artery to treat dural arteriovenous fistulas: a case report

BackgroundThe Onyx™ Liquid Embolic System is a non-adhesive liquid embolic agent, which has been proved by the US FDA for embolization of lesions in the peripheral and neurovasculature since 2005. We reported a case of ischemic optic neuropathy after using Onyx-18 to embolize the anterior ethmoid arteries that feeding dural arteriovenous fistulas (DAVF).Case presentationA 57-year-old Asian male presented with anterior cranial fossa DAVF underwent embolotherapy by delivering Onyx-18 through a microcatheter into the anterior ethmoid arteries under angiography guidance. The interventional procedure was successful and no clear evidence was found pointing to untargeted occlusive embolus. But after the surgery the patient experienced delayed painless vision loss in the right eye (RE). The fundoscopy showed unilateral papilledema with pale optic disc in RE, accompanied by significant edema and thickening in the retinal nerve fiber layer (RNFL) of macula. The fundus fluorescence angiography showed that most of the optic disc in RE had postponed or absent fluorescence filling. Visual evoked potential (VEP) confirmed that the amplitude of the P100 component was decreased in RE without significant prolongation of the latency. The patient was diagnosed with anterior ischemic optic neuropathy, but immediate pulse steroid therapy failed to rescue his vision.ConclusionPreoperative evaluation of the patient’s hemodynamic status and fundus examination are essential for assessing the risk of ischemic ocular complications, and the non-adhesive liquid embolic agent Onyx-18 should be used cautiously during endovascular embolization of intracranial artery.

Stereotactic radiosurgery for anterior cranial fossa dural arteriovenous fistulas.

Anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs) are notoriously malignant vascular abnormalities, and their drainage into the cortical vein poses a high risk of intracranial hemorrhage (ICH). Stereotactic radiosurgery (SRS) is increasingly seen as an alternative to microsurgery or embolization for the treatment of DAVFs; however, researchers have yet to report on its applicability to ACF DAVFs. This paper summarizes the authors' experience in the use of SRS for ACF DAVFs. The authors' objective was to gain a preliminary overview of SRS outcomes in the treatment of ACF DAVFs. This retrospective study examined all patients who underwent SRS for ACF DAVFs at a single academic medical center between November 2000 and November 2023. Demographic data, DAVF characteristics, and clinical outcomes were obtained from medical records. A total of 12 patients diagnosed with ACF DAVFs were treated using SRS. One patient was lost to follow-up. The mean age was 54.8 years and men comprised 82% of the cohort. The most common presenting symptoms included headache (n = 5), ocular symptoms (n = 3), seizure (n = 2), anosmia (n = 1), and tinnitus (n = 1). Two patients were asymptomatic. Four patients (36%) initially presented with ICH. Nine patients exhibited DAVF Cognard type IV, and 2 patients exhibited Cognard type III. DAVF obliteration in 7 of the 11 patients (64%) was confirmed by brain MR angiography (n = 4) or digital subtraction angiography (n = 3). No post-SRS episodes of ICH were reported. Most of the patients (10 of 11) reported improvements in clinical symptoms. SRS appears to be a viable alternative treatment for ACF DAVFs, particularly for patients who are not suitable candidates for surgery or those with an unfavorable angioarchitecture.

Transarterial embolization for anterior cranial fossa dural arteriovenous fistulas: a retrospective single-center study

BackgroundClip ligation of anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs) is the traditionally accepted first-line treatment. Endovascular treatment for ACF DAVFs may achieve good outcomes as endovascular techniques advance....

Trans-Arterial Embolization of Anterior Cranial Fossa Dural Arteriovenous Fistulas via the Sphenopalatine Artery: A Technique Report

BackgroundTrans-arterial embolization (TAE) via the ophthalmic artery and middle meningeal arterial are the common arterial routes for anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs). However, TAE via the sphenopalatine artery (SPA) to treat ACF DAVFs is rarely reported. Here, we describe 14 cases of ACF DAVFs that were either treated solely or in conjunction with other arterial routes via the SPA. A total of 15 embolization attempts were performed via the SPA. Method14 patients were treated with TAE via the SPA over a 20-year period. There were 13 males and 1 female in total, with a mean age of 57.4 (57.4±6.0) years. The clinical presentation, angiographic features, treatment strategy, and clinical outcomes were all documented. Results14 patients with ACF DAVFs underwent TAE via the SPA. Complete immediate angiographic occlusion was achieved in 78.6% of the fistulas (11/14). Complete embolization via the SPA alone was achieved in 63.6% (7/11) of the fistulas. A total of 15 embolization attempts were performed via the SPA, with a 46.7% (7/15) success rate. After TAE via the SPA, no complications were found. 42.9% (6/14) of the patients had DSA or MRA follow-up. There was no recurrence of the fistulas. ConclusionsThe SPA may be as an alternative arterial route if other appropriate arterial routes are unavailable. However, its safety and efficiency need to be confirmed further.

Copolymer liquid embolization of dural arteriovenous fistulas: A 20-year single-center experience.

Dural arteriovenous fistulas (DAVFs) with cortical venous drainage (CVD) carry significant risks of cerebral ischemia and intracranial hemorrhage. Endovascular treatment (EVT) using Onyx, a copolymer-based liquid embolic material, has become the preferred approach. However, the optimal treatment strategy for anterior cranial fossa DAVFs remains debated. This retrospective study analyzed outcomes of EVT for DAVFs in a single center from 2002 to 2023. Patient data including demographics, clinical status, angiographic findings, embolization techniques, and outcomes were recorded. The results of the anterior fossa malformations were analyzed separately afterward. A total of 195 DAVFs were included in the study. The most common presenting symptom was hemorrhage (41%), most fistulas were located in the transverse and sigmoid sinus region (48%), and the majority of DAVFs had direct CVD (78%). Transarterial embolization with Onyx was the preferred treatment strategy in majority of cases (92%). Overall, 94% of patients showed improvement or stability on the modified Rankin Scale. Two patients died due to rebleeding after partial DAVF embolization. Onyx demonstrated higher immediate complete occlusion rate compared to other embolic materials (88% vs. 35%). Overall, 91% of fistulas were closed at the last follow-up. Ten anterior fossa DAVFs were treated, resulting in clinical improvement and complete occlusion in all cases. Based on the results of our study, we believe that a cure of DAVFs, including those in the anterior fossa, can be achieved in more than 90% of cases through transarterial Onyx embolization, given long-term clinical experience.

Anterior cranial fossa osseous arteriovenous fistula of the crista galli with bone erosion: patient series

BACKGROUNDAlthough an anterior cranial fossa dural arteriovenous fistula (ACFdAVF) is thought to have a fistula on the dura near the olfactory groove, the detailed angioarchitecture remains unreported.OBSERVATIONSIn case 1, a 65-year-old man was found to have an asymptomatic ACFAVF. His computed tomography angiography (CTA)-maximum intensity projection (MIP) showed the shunt point in the crista galli (CG), with the intradural drainer penetrating the destroyed bone of the CG. In case 2, a 78-year-old man had a past history of intracerebral hemorrhage and was found to have an ACFAVF. The rotational angiography (RA)-MIP showed the intraosseous fistula in the CG with the drainer passing through a tiny bone defect of the CG. In case 3, a 35-year-old man was investigated for epilepsy. The RA-MIP showed an osseous arteriovenous fistula (AVF) in the anterior cranial base, with the drainer penetrating the skull osteolytic site. In case 4, a 73-year-old woman was found to have an asymptomatic ACFAVF. Her RA-MIP showed the osseous AVF with the drainer penetrating the CG with bone erosion.LESSSONSAll patients were diagnosed with anterior cranial fossa osseous AVF rather than dAVF, with bone erosion in the CG. These findings should be noted at the time of diagnosis and treatment.

Endovascular treatment of anterior cranial fossa dural arteriovenous fistula: a multicenter series.

We report a multicenter experience using endovascular embolization as the first line approach for treatment of anterior cranial fossa (ACF) dural arteriovenous fistula (DAVF). All patients with DAVFs located in the anterior cranial fossa who were treated with endovascular technique as a first line approach were included. Demographics, clinical presentation, angioarchitecture, strategy, complications, immediate angiographic, and follow-up results were included in the analysis. Twenty-three patients met the inclusion criteria (18 male and 5 female). Age ranged from 14 to 79years (mean 53years). Twelve patients presented with hemorrhage. Twenty-eight endovascular procedures were performed. The overall immediate angiographic cure rate after endovascular treatment was 82.6% (19/23 patients). The angiographic cure rate of the transvenous strategy was significantly superior to the transarterial strategy (p ≤ 0.001). There was 1 complication in 28 total procedures (3.6%). Angiographic follow-up was available in 21 out of the 23 patients with a mean of 25months (range 2 to 108months). In these 21 patients, the DAVF was completely cured in 20 (95%). At last follow-up, all patients had a modified Rankin scale (mRS) 0 to 2. Our experience suggests that endovascular treatment for ACF DAVFs has an acceptable safety profile with high rates of complete occlusion, particularly with transvenous approach. Whenever possible, transvenous approach should be preferred over transarterial approach as first line strategy.

Anterior cranial fossa dural arteriovenous fistula with pial arterial supply

Anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs) are mainly fed by the ethmoidal arteries and sometimes have pial arterial feeders. DAVFs with pial arterial supply in ACF are extremely rare because most of the reported cases of DAVFs with pial arterial supply are located at the transverse sigmoid sinus and tentorium. A 68-year-old male presented with dizziness. Angiography showed cortical venous reflex (CVR) through an ACF DAVF fed by both bilateral ethmoidal arteries and by the right orbitofrontal artery as a pial feeder. The ethmoidal feeders were disconnected by craniotomy. The pial arterial feeder from the anterior cerebral artery was not found during surgery, and disconnection of the draining vein was not performed. CVR showed a significant reduction after the surgery. After 2 years of follow-up, angiography revealed an increased shunt flow from the pial feeder. Endovascular treatment using n-butyl-2-cyanoacrylate was performed, resulting in the complete occlusion of the fistula. DAVFs with pial supply are reported to carry a high risk of perioperative complications because of the restriction of the venous outflow and retrograde thrombosis of the pial artery. Endovascular pial feeder occlusion after surgical dural arterial feeder disconnection might achieve a safe and effective outcome. With close follow-up, the recurrence of increased shunt flow may be an appropriate timing for additional treatment. This rare condition may offer a new insight into the mechanisms of pial feeder development.

Embolization of anterior cranial fossa dural arteriovenous fistula

Dural arteriovenous fistulas (DAVFs) are abnormal connections between branches of the intracranial arteries and dural veins or sinuses. Advancements in the technique of endovascular embolization has made it the treatment of choice for DAVFs. The goal of treatment is to completely occlude the fistula orifice while maintaining the normal cerebral venous drainage. Depending on the site of the DAVF, endovascular treatment has its own challenges to the performing physician. In this case report, we will discuss complex anterior cranial fossa DAVFs, treatment approaches, and complications of the treatment.

Embolization of anterior cranial fossa dural arteriovenous fistula

Dural arteriovenous fistulas (DAVFs) are abnormal connections between branches of the intracranial arteries and dural veins or sinuses. Advancements in the technique of endovascular embolization has made it the treatment of choice for DAVFs. The goal of treatment is to completely occlude the fistula orifice while maintaining the normal cerebral venous drainage. Depending on the site of the DAVF, endovascular treatment has its own challenges to the performing physician. In this case report, we will discuss complex anterior cranial fossa DAVFs, treatment approaches, and complications of the treatment.

Clinical Characteristics and Microsurgery Treatment of Anterior Cranial Fossa Dural Arteriovenous Fistula.

Anterior cranial fossa dural arteriovenous fistulas (DAVFs) represent 6% of all intracranial DAVFs and have a high risk of intracranial hemorrhage. To analyze the clinical characteristics and microsurgery treatment of anterior cranial fossa DAVFs, a retrospective review of 21 patients with anterior cranial fossa DAVFs undergoing microsurgery was performed, including 8 bleeding patients and 13 non-bleeding patients. The Glasgow coma scale (GCS) scores were used to evaluate the conscious states of 8 bleeding patients before and after operation. All patients had no obvious complications and the clinical symptoms were improved after operation. No abnormal fistulas and drainage veins were detected by digital subtraction angiography postoperatively. The GCS scores of 8 bleeding patients showed that the conscious states became better than pre-operation. Of the 21 patients, 9 patients were followed up without recurrence. Taken together, microsurgery is an effective method for the treatment of anterior cranial fossa DAVFs and it is very important for the improvement of bleeding patients' conscious states.

Surgical treatment of anterior cranial fossa dural arterio-venous fistulas (DAVFs): a two-centre experience.

Anterior cranial fossa dural arterio-venous fistulas (DAVFs) represent 6% of all intracranial DAVFs; characteristically they show an aggressive behaviour with high risk of intracranial haemorrhage. Peculiar anatomical features, such as feeding by the ethmoidal arteries and the pattern of venous drainage (frequently with varices that mimic aneurysmal dilatation), can be evaluated in detail only by digital subtraction angiography (DSA), which represents the "gold standard" in the diagnosis of such cranial fistulas. Recent technological developments in endovascular management of this type of DAVF have partially reduced the morbidity risk related to this modality of treatment. Our purpose is to present our experience in the surgical management of 14 patients with anterior cranial fossa DAVFs, with attention paid to the possible role of preoperative embolisation in these cases and to the surgical technique. Between 1999 and 2015, 14 patients with anterior cranial fossa DAVFs were submitted to surgery in two neurosurgical departments; the mean age was 63years old; nine DAVFs caused intracranial haemorrhage (subarachnoid haemorrhage in three cases, intracerebral haemorrhage in six cases). Pre-operative embolisation was attempted in an early case and was successfully done in one recent case. In all patients, the surgical approach chosen was a pterional craniotomy with a low margin on the frontal bone in order to gain the exposure of the anterior cranial fossa and especially of the olphactory groove region; the resection of the falx at its insertion on the crista galli was needed in five cases in order to get access to the contralateral afferent vessels. Cauterisation of all the dural feeders on and around the lamina cribrosa was needed in all cases; venous dilatations were evident in eight patients (in seven out of nine patients with ruptured DAVF and in one out of five patients with unruptured DAVF) and were removed in all cases. One patient harboured an ophthalmic artery aneurysm, which was excluded by clipping. One patient died 5days after surgery due to the severity of the pre-operative haemorrhage. Postoperative DSA showed the disappearance of the DAVF and of the venous pseudo-aneurysms in all cases. Clinical outcome was favourable (without neurological deficits) in 11 patients; three patients presented an unfavourable clinical outcome, due to the severity of the initial haemorrhage. Surgical exclusion of the anterior cranial fossa DAVFs still represents the gold standard for such lesions, due to low post-operative morbidity and to complete protection against future rebleedings; endovascular techniques may help the surgeon in complex cases.

Interhemispheric approach for endoscopic ligation of an anterior cranial fossa dural arteriovenous fistula

We describe the endoscopic ligation of an anterior cranial fossa (ACF) dural arteriovenous fistula (DAVF) through an interhemispheric approach. Intracranial DAVF of the ACF are rare and associated with an aggressive natural history, due to their ubiquitous direct cortical venous drainage and frequent coincidence of venous ectasia. Although surgical ligation is the preferred treatment for ACF DAVF, the role of endoscopy in the surgical management of DAVF is undefined. A 53-year-old woman was incidentally diagnosed with an ACF DAVF. Cerebral angiography showed a Borden type III, Cognard type IV left sided ACF DAVF, supplied by ethmoidal branches of the bilateral ophthalmic arteries and draining directly into an enlarged and ectatic left inferior frontal cortical vein, with a venous varix distal to the point of fistulization. An initial attempt at endovascular treatment from a transvenous approach was unsuccessful, due to significant stenosis of the left cavernous sinus. Therefore, we elected to proceed with surgical ligation. From an interhemispheric approach and under the guidance of frameless stereotactic neuronavigation, a 0° endoscope was advanced into the interhemispheric fissure until the arterialized draining vein was visualized. After dissecting along the draining vein to the point of fistulization, the proximal portion of the draining vein was ligated. Intraoperative angiography confirmed complete obliteration of the DAVF, and the patient was asymptomatic at the 6week postoperative follow-up. Endoscopy provides excellent visualization of ACF DAVF and can safely facilitate surgical treatment in appropriately selected patients with these lesions.

Bilateral ophthalmic-ethmoidal dural arteriovenous fistula presenting with intracranial hemorrhage: a rare entity

Dural arteriovenous fistulas (DAVFs) are rare lesions. The most common locations of DAVFs are cavernous, sigmoid and transverse sinuses. Anterior cranial fossa is one of the less frequent placement for DAVFs and the risk of hemorrhage in this region is increased. Reported hemorrhage risks have been ranged from 62 to 91 %, and an aggressive clinical course is more likely than a benign clinical course. A 47-year-old man was admitted to our emergency room with headache and the computed tomography revealed frontal hemorrhage. Neurological examination was normal. We applied cerebral angiography in our interventional neurology department and an anterior cranial fossa DAVFs, supplied by bilateral ophthalmic-ethmoidal arteries, was determined. DAVFs are a rare cause of intracranial hemorrhages and in the literature anterior cranial fossa DAVFs have been reported scarcely, so that we aimed to present this rare entity.

Transarterial treatment with Onyx of Cognard type IV anterior cranial fossa dural arteriovenous fistulas

Background and purposeCognard type IV anterior cranial fossa dural arteriovenous fistulas (DAVFs) are rare lesions with a high risk of intracranial hemorrhage. We present our experience with the use of...

Transarterial embolization of dural arteriovenous fistulas of the anterior cranial fossa with Onyx

Dural arteriovenous fistulas (DAVF) of the anterior cranial fossa are often associated with hemorrhage and are usually treated surgically. This clinical study summarizes our preliminary experience in the transarterial embolization of these lesions. We retrospectively reviewed the data for 11 patients with anterior cranial fossa DAVF who underwent transarterial embolization with the Onyx Liquid Embolic System (eV3 Endovascular, Plymouth, MN, USA) at our institute between 2007 and 2011. In four patients, a balloon-assisted technique was used to facilitate superselective catheterization. According to the Cognard classification of DAVF, three fistulas were type III, and the other eight were type IV. DAVF were completely obliterated in 10 patients after treatment via a single ethmoidal artery, but the other patient was not completely cured. No signs of rebleeding or symptom progression were observed at a mean follow-up of 18.5months (range: 2–49months). Transarterial embolization using Onyx is therefore feasible and effective for the management of DAVF of the anterior cranial fossa.

前頭蓋窩硬膜動静脈瘻

Dural arteriovenous fistulas (DAVFs) of the anterior cranial fossa are rare anomalies that invariably present with cortical venous reflux because of the absence of dural sinus in the affected region. Previous reports have identified intracranial hemorrhage as the major symptom and have confirmed that good surgical outcome can be obtained by open surgery. Recently, however, the widespread use of MRI has led to an increase in the incidental detection of asymptomatic DAVFs of the anterior cranial fossa. Treatments for these asymptomatic lesions are now a focus of discussion. We treated four patients with anterior cranial fossa DAVFs between 2005 and 2010. One of the patients presented intracranial hemorrhage and the other three were asymptomatic. The three patients with intracranial hemorrhage underwent open surgery and the other asymptomatic patient underwent endovascular surgery. The latter patient initially underwent transarterial embolization with only partial success. The patient was completely cured by the transvenous approach with platinum coils. All four patients were successfully treated without any adverse events. Previous papers reported similarly high annual intracranial hemorrhage rates from DAVFs with cortical venous reflux. This suggests that surgical treatment for asymptomatic patients with anterior cranial fossa DAVFs should be considered. Direct surgery has been the treatment of choice for this disease so far. For asymptomatic patients, however, endovascular treatment with transvenous embolization may serve as an effective alternative to open surgery.

Anterior Cranial Fossa Dural Arteriovenous Fistula With Bilateral Cortical Drainers -Case Report-

A 58-year-old man presented with sudden onset of severe headache. Computed tomography demonstrated subarachnoid hemorrhage and right acute subdural hematoma. He had no neurological deficits. Cerebral angiography showed an anterior cranial fossa dural arteriovenous fistula (AVF) supplied by the bilateral ethmoidal arteries. A fistula was suggested on the right side, and the dural AVF drained into the superior sagittal sinus via the bilateral frontal cortical veins. Venous varix was observed at both drainage sites. Bifrontal craniotomy with right-side dural incision was performed and the fistula was interrupted. Postoperative angiography demonstrated a persistent fistula draining into the left cortical vein. Nineteen days later, bifrontal craniotomy with left-side dural incision was performed and the draining vein was completely coagulated with the aid of intraoperative angiography. Postoperatively, there was no detectable residual fistula. He was discharged without neurological deficits 2 weeks after surgery. The present case of anterior cranial fossa dural AVF with bilateral cortical drainers shows that drainer occlusion at two points may be needed for complete obliteration of the drainers because the fistulous connection may not be simple.

A Dural Arteriovenous Fistula of the Anterior Cranial Fossa Angiographically Mimicking an Anterior Ethmoidal Artery Aneurysm

Venous aneurysm or varix at the venous side of the fistula commonly exist in dural arteriovenous fistula (DAVF) of the anterior cranial fossa, which may be initially mistaken with aneurysm on computed tomography and magnetic resonance imaging, but always identified by angiography. We report a very unusual case of anterior cranial fossa DAVF angiographically mimicking an anterior ethmoidal artery aneurysm, which was ultimately corrected by surgery. A 41-year-old male presented with right frontal intraparenchymal hematoma with intraventricular extension. Angiography revealed a vascular lesion adjacent to the anterior fossa mimicking an anterior ethmoidal artery aneurysm, which was surgically proven to be a partially thrombosed venous varix of drainaging vein originated from the cribriform plate. A diagnosis of anterior cranial fossa DAVF was made, and venous varix was excised. Follow-up angiography after the operation revealed complete disappearance of the lesion. Our case illustrates a unique occasion that a proximal venous varix without obvious outflow angiographically in DAVF might be mistaken with an aneurysm.

Endovascular embolization of dural arteriovenous fistulas of the anterior cranial fossa: three case reports

Objective and importance: Anterior cranial fossa dural arteriovenous fistulas (DAVFs) are rare intracranial lesions with a high risk of intracranial hemorrhage. We describe three cases of patients with DAVFs of the anterior cranial fossa.Clinical presentation: Case 1 is a 65-year-old man with chronic dementia and seizure, case 2 is a 52-year-old man with intraparenchymal hemorrhage and case 3 is a 48-year-old man complaining of headaches and visual disturbance. Angiography revealed DAVFs of the anterior cranial fossa in these patients.Intervention: Three patients were all successfully treated endovascularly without any adverse events. Cases 1 and 3 were cured by transvenous approach with platinum coils. Case 2 was embolized via transarterial approach with Onyx-18, which had not been reported previously.Conclusion: Along with advancements of endovascular technique, endovascular embolization may still play an important role in treatment of anterior cranial fossa DAVF.