Multiple Dural Arteriovenous Fistulas Research Articles

Radiosurgery as a Stand-Alone Treatment Option for Cerebral Dural Arteriovenous Fistulas: the Vienna Series.

Gamma Knife radiosurgery (GKRS) has been demonstrated to be an effective and safe treatment method for dural arteriovenous fistulas (DAVFs). However, only few studies, mostly with limited patient numbers, have evaluated radiosurgery as a sole and upfront treatment option for DAVFs. Thirty-three DAVF patients treated with GKRS as a stand-alone management at our institution between January 1992 and January 2020 were included in this study. Obliteration rates, time to obliteration, neurologic outcome, and complications were evaluated retrospectively. Complete overall obliteration was achieved in 20/28 (71%) patients. The postradiosurgery actuarial rates of obliteration at 2, 5, and 10 years were 53, 71, and 85%, respectively. No difference in time to obliteration between carotid-cavernous fistulas (CCFs; 14/28, 50%, 17 months; 95% confidence interval [CI]: 7.4-27.2) and non-CCFs (NCCFs; 14/28, 50%, 37 months; 95% CI: 34.7-38.5; p = 0.111) were found. Overall, the neurologic outcome in our series was highly favorable at the time of the last follow-up. A complete resolution of symptoms was seen in two-thirds (20/30, 67%) of patients. One patient with multiple DAVFs suffered from an intracranial hemorrhage of the untreated lesion and died during the follow-up period, resulting in a yearly bleeding risk of 0.5%. No complications after radiosurgery were observed in our series. Our results show that GKRS is a safe and effective stand-alone management option for selected DAVF patients.

Multiple dural arteriovenous fistulas as the mystery of rapidly progressive dementia with bilateral thalamic lesions (P12-5.009)

<h3>Objective:</h3> Dementia is a gradual and irreversible loss of higher mental function, particularly memory. Dural arteriovenous fistulas (DAVFs) are one of the rare causes of a rapid decline in cognitive function, which can be curable. DAVFs are pathological shunts between the dural artery and the dural venous sinus, dural vein, or cortical vein. Here, we present a case that initially manifested nausea and dizziness and developed rapidly progressive dementia caused by DAVFs in the left transverse sinus-sigmoid sinus junction area and the sinus confluence area, combined with cerebral venous sinus thrombosis. Moreover, our case has multiple DAVFs that cause bilateral thalamic lesions and rapidly progressive dementia called thalamic dementia, which is infrequent and often misdiagnosed. His symptoms have improved after receiving endovascular embolization treatment. In addition to presenting our case, we conducted a systemic literature review to summarize how familiarity with the manifestation and early diagnosis of bilateral thalamic lesions caused by DAVFs can lead to earlier and more effective therapy. <h3>Background:</h3> . <h3>Design/Methods:</h3> . <h3>Results:</h3> . <h3>Conclusions:</h3> . <b>Disclosure:</b> Dr. Al-Nusaif has nothing to disclose. Dr. Yu has nothing to disclose. Prof. C has nothing to disclose.

Multiple Dural Arteriovenous Fistulas Presenting as Objective Pulsatile Tinnitus and Evaluated Using Four-Dimensional Contrast-Enhanced MR Angiography.

Multiple Dural Arteriovenous Fistulas Presenting as Objective Pulsatile Tinnitus and Evaluated Using Four-Dimensional Contrast-Enhanced MR Angiography.

Multiple Dural Arteriovenous Fistulas in the Superior Sagittal Sinus Region with Reversible Parkinsonism and Urinary Incontinence as Rare Presentations: A Case Report

Background: Dural Arteriovenous Fistula (DAVF), characterized by abnormally direct connections between meningeal arteries and meningeal veins or dural venous sinuses, is a rare subtype among the intracranial arteriovenous malformations. Although the clinical manifestations of DAVF are very variable depending on the locations and size of venous drainage, parkinsonism and urinary incontinence are rarely reported. Here, we present a rare case with parkinsonism and urinary incontinence secondary to DAVF. Case Presentation: A 50-year-old man was admitted for a progressively worsening weakness of his left lower limb over a year with urinary incontinence for four months. Neurological examination revealed rigidity and bradykinesia of the left upper limb without an obvious tremor. Magnetic resonance imaging exhibited diffuse white matter hyperintensities in bilateral centrum semiovale. Cranial magnetic resonance venography revealed extensive tortuous venous malformations. Digital subtraction angiography exhibited multiple bilaterally distributed DAVF in the superior sagittal sinus, supplied by bilateral occipital arteries and superficial temporal arteries. In the one year follow-up, the patient with multiple DAVF bilaterally distributed was completely cured after endovascular treatment according to the symptoms and the follow-up imaging results. Conclusion: This report enriches the clinical presentations of DAVF with parkinsonism and urinary incontinence, which is a crucial diagnostic clue to be aware of the possibility. Moreover, these rare symptoms can be relieved by timely endovascular treatment.

Seizure Outcome in Patients with Seizure-Associated Dural Arteriovenous Fistulas

To evaluate seizure outcome in patients with seizure-associated dural arteriovenous fistulas (DAVFs). Between 2001 and 2019, 1198 consecutive patients underwent treatment for DAVFs in our neuroscience institute. Among these, 48 patients presented with initial seizure before treatment. The seizure outcome after treatment were assessed by patients' medical records, updated clinical information, and, when necessary, direct patient contact. Cortical venous reflux was present in all 48 patients with a history of seizure, including 36 cases with single fistula and 12 cases with multiple DAVFs. Complete angiographic occlusion of DAVFs was achieved in all patients at the latest follow-up. There were no immediate or long-term persistent complications after treatment. At 1-year follow-up, 54.2% (26/48) of the patients were seizure-free, and 29.2% (14/48) were medication-free. At 2-year follow-up, 81.3% (39/48) were seizure-free, and 64.6% (31/48) were medication-free. At the last follow-up (mean 7.9 years), 93.8% (45/48) were seizure-free, and 81.3% (39/48) were medication-free. Fewer than 5 seizures before treatment and a seizure history of <3 months before treatment were 2 independent predictive factors for higher seizure-free rate at 1-year follow-up (before P < 0.05) as well as independent predictive factors for higher medication-free rate at 2-year follow-up (both P < 0.05). DAVF-related seizures can be effectively controlled through treatment of DAVF. Short seizure history and fewer seizures before treatment predict satisfactory seizure outcome after DAVF treatment, which indicates early treatment for seizure-associated DAVFs.

Multiple Dural Arteriovenous Fistulas Presenting as Pulsatile Tinnitus.

Multiple Dural Arteriovenous Fistulas Presenting as Pulsatile Tinnitus.

Venous encephalopathy

Dural arteriovenous fistulae (DAVF) accounts for 10-15% of rare acquired intracranial vascular malformations which can present with a wide range of symptoms but DAVF presenting with onset of encephalopathy and cognitive decline as non-hemorrhagic neurological deficits has rarely been reported. A 44-year-old gentleman complained of headache followed by episodes of confusional behavior presenting to the emergency with two episodes of GTC seizures. He had history of cortical superficial venous sinus thrombosis and was treated with anticoagulants for one year. On admission his vitals were stable, GCS-6, no meningeal signs but decerebrate posturing with bilateral extensor planter response. CT venography reported non-opacification of superior sagittal, straight, left transverse and bilateral sigmoid sinuses (Fig1&2). Extensive collateral venous channels were seen in brain, parenchyma, basal cisterns and along the convexities. Few types of collateral were opacified in the arterial phase though intracranial arteries were normal. DSA revealed multiple DAVF (>5) fed by various arteries (Fig3&4). Endovascular embolization and recanalization was attempted but was not successful and patient was started on subcutaneous heparin. DAVF is referred to the abnormal communication between the intracranial artery and dural venous sinuses. DAVF can present with a myriad of clinical features so it is frequently misdiagnosed. The two unique features in this patient of DAVF were the presence of multiple sinuses and rare clinical presentation as venous encephalopathy. We assume that in this case the transformation in symptomatology from encephalopathy to seizures was heralded by increased arterial blood supply due to multiple sites of the fistulae.

Treatment of Multiple Dural Arteriovenous Fistulas Associated with Visual Disturbances in a Chronic Schizophrenia Patient: A Case Report

A 51-year-old woman presented with visual disturbances that had persisted for approximately one year. She had been taking psychiatric medication for schizophrenia. Brain magnetic resonance imaging showed engorged vessels in both hemispheres, and a delay in the mean transit time and time to peak was observed on perfusion images. The initial transfemoral cerebral angiography showed multiple dural arteriovenous fistulas (AVFs) with cortical venous reflux and venous ectasia. Both middle meningeal arteries (MMAs), superficial temporal arteries (STAs), and occipital arteries (OAs) were feeding the fistulas, and the superior sagittal sinus was the draining vein. Owing to the presence of multiple lesions and feeder arteries, a staged treatment was planned. We first performed the Onyx embolization of the left MMA, followed by the surgical ligation of the left STA, with subsequent embolization of the left OA. Finally, the venous ectasia was clipped. Importantly, after treatment, the patient’s schizophrenia-like symptoms improved. The patient could be originally misdiagnosed with schizophrenia. This case shows that staged and active treatment should be considered in case of multiple dural AVFs for improvement of symptoms. Key words: Arteriovenous fistula; Intracranial arteriovenous malformations; Schizophrenia

De Novo Multiple Dural Arteriovenous Fistulae Successfully Treated with Transarterial Embolization Using Low-concentration N-butyl-2-cyanoacrylate: A Case Report

De Novo Multiple Dural Arteriovenous Fistulae Successfully Treated with Transarterial Embolization Using Low-concentration N-butyl-2-cyanoacrylate: A Case Report

Progress in research on intracranial multiple dural arteriovenous fistulas.

Intracranial multiple dural arteriovenous fistulas (MDAVFs) are rare lesions that are difficult to treat. The key factors involved in the development of MDAVFs remain unknown. At present, the majority of reports on intracranial MDAVFs are confined to case reports and small case series, and thus understanding of MDAVFs is limited. The current review assesses the available literature to date with the aim of reviewing the progress in research on intracranial MDAVFs. Intracranial MDAVFs may be divided into two types: Synchronous and metachronous. While the exact pathogenesis of MDAVFs is unknown, a number of possible mechanisms are considered relevant. The first is that MDAVFs develop following recanalization of a large sinus thrombosis that involves several sinuses. The second possibility is that a pre-existing DAVF may induce sinus thrombosis or venous hypertension, resulting in a new MDAVF. The third is that MDAVFs are caused by increased angiogenic activity, which may induce the development of MDAVFs. Intracranial MDAVFs have a malignant clinical course, and their symptoms generally rapidly progress following onset. It is therefore important to identify intracranial MDAVFs at an early stage. A number of imaging technologies, including computed tomography (CT), magnetic resonance imaging (MRI), digital subtraction angiography (DSA) and single-photon emission computed tomography (SPECT), may be used to detect MDAVFs. Of these, CT and MRI provide information on brain morphology, SPECT provides brain blood flow information, and DSA is the gold standard that may be used to identify angioarchitecture and hemodynamics. MDAVFs require timely and aggressive treatment, which may include endovascular embolization, surgical resection, radiosurgery and conservative treatment, and in some cases, combined treatments are required. Appropriate and aggressive treatment regimens can markedly improve neurological deficits and cognitive function in patients with MDAVFs.

Multiple Dural Arteriovenous Fistulas Presenting as Pulsatile Tinnitus Treated with External Manual Compression.

Dural arteriovenous fistula (DAVF) have been treated by transarterial or transvenous embolization, surgery, and radiosurgery. Besides these treatment options, the external compression technique is a non-invasive, low-cost form of treatment. This article reports that a 60-year-old man with DAVF between multiple arterial branches and transverse/sigmoid sinus was treated by repeated external manual compression method.

Demencia rápidamente progresiva y parkinsonismo asociados a múltiples fístulas arteriovenosas durales

Rapidly progressive dementias are an infrequent group of diseases characterised by cognitive deterioration and other neurological disorders that develop over a period ranging from weeks to months. Their causation is varied and includes a large number of neurodegenerative, toxic, metabolic, autoimmune, infectious and vascular conditions. We report the case of a 69-year-old male who was admitted to hospital due to a rapidly progressive dementia and parkinsonism caused by multiple dural arteriovenous fistulas, which were successfully treated by means of endovascular therapy. Dural arteriovenous fistulas are anomalous connections between the dural arteries and the venous sinuses or cortical veins that are an unusual cause of rapidly progressive dementia. They must, however, be taken into account, given the availability of a specific treatment with reversal of the symptoms.

Multiple intracranial dural arterivenous fistulas in a girl with Cowden Syndrome - a case report

Dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous shunts that occur in the dura of the central nervous system. Multiple DAVFs present in a nine year old girl with Cowden Syndrome (CS) diagnosis is presented in this article.

Multiple Dural Arteriovenous Fistulas Causing Rapid Progressive Dementia Successfully Treated by Endovascular Surgery: Case Report

A 67-year-old female presented with multiple dural arteriovenous fistulas (AVFs) manifesting as dementia rapidly progressing over 2 months. The initial diagnosis was Creutzfeldt-Jakob disease based on the acute clinical course. However, angiography eventually revealed multiple dural AVFs involving the bilateral convexities to the superior sagittal sinus and the right transverse-sigmoid sinus. Endovascular treatment combining arterial and venous embolization in multiple stages proved to be effective, as the hemodynamic pathology improved, and the patient recovered from dementia. The cause of the dementia was thought to be venous hypertension in the deep white matter induced by the dural AVFs. Dural AVFs should be included in the differential diagnosis of rapidly progressive dementia.

De novo multiple dural arteriovenous fistulas and arteriovenous malformation after embolization of cerebral arteriovenous fistula: case report

A cerebral arteriovenous fistula is a rare neurovascular abnormality. It is very scarce when presenting with other cerebral arteriovenous malformations after embolization. We reported a case primarily presenting with cerebral arteriovenous fistula. When the fistula was embolized completely, de novo multiple dural arteriovenous fistulas and a small arteriovenous malformation occurred due to the hemodynamic change after the embolization. Embolization of parts of the fistulas for the second time led to an untreatable malformation which became curable. At the third time, the remaining fistula was cured. The mechanism of the dural arteriovenous fistula and treatment strategy were discussed. Venous hypertension is the main factor causing a dural arteriovenous fistula. Embolization of the fistulas step by step is recommended.

Multiple Dural Arteriovenous Fistulas Presenting as Rapidly Progressive Dementia

Dural arteriovenous fistulas (DAVFs) are important causes of neurological dysfunction and are many times misdiagnosed. Particularly in older populations, DAVFs may present with a selective cognitive dysfunction. The authors describe a 70-year-old woman presenting with a rapidly progressive dementia, very similar in presentation to prion disease. Neuroimaging showed multifocal DAVFs associated with venous thrombosis and white matter changes, suggesting that impaired cerebral circulation due to venous hypertensive encephalopathy caused the patient's dementia. Prompt treatment of some of the abnormal shunts with endovascular embolization resulted in a clinically relevant improvement. Subsequent clinical improvement was achieved with anticoagulation, although no cause or predisposing factor was documented that could have led to the development of the venous thrombosis. Neurologists should maintain a high degree of suspicion to avoid missing the diagnosis of DAVFs that are potentially treatable lesions.

Multiple spinal and cranial dural arteriovenous fistulas

Synchronous multiplicity of cranial and spinal dural arteriovenous fistulas (DAVFs) is known but uncommon. The authors report on a patient with the unusual finding of multiple cranial and multiple separate spinal DAVFs. The patient initially presented with vague visual symptoms in 2004. A cranial DAVF was identified along the left transverse sinus with cortical venous reflux and another DAVF was identified along the posterior part of the superior sagittal sinus with no cortical venous reflux. The first DAVF was treated both endovascularly and surgically and the second was left untreated. The follow-up angiogram showed multiple spinal DAVFs at the levels of C-1, C-2, and C-6 on the left side and at the C-3 level on the right side along with another cranial DAVF along the anterior part of the superior sagittal sinus with cortical venous reflux. A retrospective analysis of the digital subtraction angiogram and MR images suggested that the cervical spinal DAVFs were already present in 2004 (6 years previously). Multiple DAVFs, although rare, do exist and it is important to look for any evidence of their presence when evaluating patients with symptoms suggestive of arteriovenous fistulas.

海綿静脈洞と後頭蓋窩に発生した多発性硬膜動静脈瘻の2症例

多発性硬膜動静脈瘻の2症例を報告する.症例1は複視を主訴とする73歳女性で,左海綿静脈洞部と左横・S状静脈洞に硬膜動静脈瘻が認められた.脳橋に逆行性静脈還流を呈する海綿静脈洞部の病変に対し経静脈的塞栓術を施行し,逆行性還流を遮断した.症例2は複視を主訴とする75歳の女性で,右静脈洞交会近傍と左海綿静脈洞部に硬膜動静脈瘻を認めた.それぞれ経動脈的塞栓術を施行し,動静脈瘻を閉塞した.多発性硬膜動静脈瘻は硬膜動静脈瘻全体の7〜8%といわれ,逆行性静脈還流を呈するものが多いのが特徴である.血行動態を含めた的確な診断と,迅速な対応が必要である.

Multiple dural arteriovenous fistulas developing after total removal of parasagittal meningioma: a case successfully treated with transvenous embolization

Dural arteriovenous fistulas (dAVFs) have recently been recognized as resulting from several acquired factors, such as venous sinus thrombosis, intravenous hypertension, head injury and surgery. Although cases of post-operative dAVF have been reported, most of these lesions have been located close to the operation site. However, we encountered a case of multiple dAVFs that developed distant to the preceding surgery. This report discusses the pathogenesis of post-operative dAVFs and reviews the literature concerning the treatment of dAVFs occurring at the skull base.

Transarterial Wedged-catheter, Flow-arrest, N-butyl Cyanoacrylate Embolization of Three Dural Arteriovenous Fistulae in a Single Patient

The pathogenesis of dural arteriovenous fistulas (DAVFs) is currently unknown, with multiple DAVFs being rare. For patients with limited venous access secondary to sinus thrombosis, or for patients where parent sinus occlusion would not be tolerated, transvenous embolization may not be possible and other treatment methods must be considered. A 69-year-old female patient with a two-year history of progressive headaches, memory loss, and unsteady gait underwent cerebral angiography that revealed three separate DAVFs with congested cortical venous drainage overlying both frontal lobes. Using an application of a transarterial wedged-catheter, flow-arrest technique, N-butyl cyanoacrylate was deposited across all three pathologic arteriovenous connections providing a definitive cure. Transarterial NBCA embolization may provide curative treatment of DAVFs, and is of particular utility in situations where access to the draining venous structures is limited.