Multiple Dural Arteriovenous Fistulas Research Articles

Multiplicity of dural arteriovenous fistulas

Dural arteriovenous fistulas (AVFs) are a well-known pathoanatomical and clinical entity. Excluding bilateral involvement of the cavernous sinus, multiple dural AVFs are rare, with isolated reports in the literature. The additional risk associated with multiplicity is unknown, although it has been claimed that there is a greater risk of hemorrhage at presentation. In a group of 284 patients with dural AVFs consecutively treated at a single center, the occurrence of multiplicity is investigated and its risk factors for hemorrhage are identified. Among the 284 patients with both cranial and spinal dural AVFs, 20 patients with multiple fistulas were found. Nineteen (8.1%) of 235 patients with cranial AVFs had multiple cranial fistulas, and one (2%) of 49 patients with spinal AVFs harbored two spinal fistulas. Twelve patients were found to have a lesion at two separate sites, seven patients had them at three locations, and one patient had four fistulas, each at a different site. In the subgroup with multiple AVFs the percentage of hemorrhage at presentation was three times higher than in the entire group (p = 0.01). Cortical venous drainage in cranial fistulas was present in 84% of patients with multiple lesions compared with 46% of patients with solitary lesions (p < 0.005). Multiple dural AVFs are not rare. In this group of 284 patients it was found in 8.1% of all patients with cranial dural AVFs. Multiplicity was associated with a higher percentage of cortical venous drainage, a pattern of drainage reportedly yielding a higher risk for hemorrhage.

Multiple dural arteriovenous fistulae involving the cavernous and sphenoparietal sinuses

A 72-year-old woman who presented with a unilateral oculomotor nerve palsy was shown to have a very rare condition: multiple dural arteriovenous fistulae (DAVF) involving the cavernous and sphenoparietal sinuses. The sphenoparietal DAVF was cured completely by transarterial embolisation. Symptomatic relief was accomplished by this procedure. The cavernous sinus DAVF progressed to acquire cortical venous drainage, and was obliterated completely by transvenous embolisation.

Development of a dural arteriovenous fistula around the jugular valve after transvenous embolization of cavernous dural arteriovenous fistula

Background Endovascular therapy for dural arteriovenous fistulas (DAVFs) is not without any risks, although it has been generally accepted to be a safe procedure. In this paper, we report a very rare complication: metachronous DAVF around a jugular valve 4 months after transvenous embolization. Case Description A 43-year-old woman presented with left proptosis, chemosis, and double vision. Cerebral angiography demonstrated a left cavernous DAVF. The patient’s symptoms resolved almost completely after embolization with platinum coils via the superior ophthalmic vein. Four months later, angiography revealed a metachronous DAVF around a jugular valve. Conclusion To our knowledge, only four such cases have been reported in the literature. Careful follow-up of patients treated with transvenous embolization and accumulation of such cases are needed to understand the pathogenesis of multiple DAVFs.

Transvenous embolization of dural fistulas

Three patients with dural arteriovenous fistulas (DAVFs) involving the transverse, sigmoid and superior sagittal sinuses were treated by transvenous embolization with coils. Two patients underwent firstly transarterial embolizations without complete angiographic cure. In a second endovascular treatment a 5 French catheter was advanced from a femoral vein access into the internal jugular bulb and the Tracker 18 catheters were navigated through the sinus lumen into the involved cortical veins or the parasinusal venous draining channels of the DAVFs. The venous recipients at the level of the nidus area of the DAVFs were selectively occluded by fibered platinum coils. There was a complete angiographic cure in both patients with occlusion of the venous recipients and the nidus of the DAVFs, and the sinus segments next to the nidus of the DAVFs remained patent. The third patient had multiple DAVFs with complete thrombosis of his ipsilateral sigmoid sinus. He was treated initially with transvenous approach through the contralateral jugular bulb. The coils were placed within the venous recipient adjacent to the incomplete thrombosed ipsilateral transverse sinus. It achieved a 90% reduction of the flow. The placement of coils via a transsinusal route into the venous channel of a dural fistula, yet outside the sinus lumen, can result in an obliteration of the fistula, without any damage of the physiological function of the dural sinuses.

Embolization of intracranial arteriovenous malformations and fistulas with polyvinyl alcohol particles and platinum fibre coils.

In order to reduce the recanalization rate of arteriovenous malformations and multiple dural arteriovenous fistulas, embolization was carried out with polyvinyl alcohol (PVA) particles combined with platinum fibre coils in 20 patients. The malformation was occluded more effectively than by PVA alone. Distal deposition of the emboli was obtained by improved steerable catheters (Tracker-18-unibody) and guidewires. The complication rate was lower than usually reported from studies using glue as embolic agent. It was concluded that the combination of PVA and fibre coils enhances the safety and effectiveness of embolization therapy and reduces the frequency of recanalization of intracranial AVMs.