Bilateral ethmoidal dural arteriovenous fistulae

a previously unreported entity: case report.

Vivek R. Deshmukh, Steve Chang, Felipe C. Albuquerque, Cameron McDougall, Robert F. Spetzler

Research output: Contribution to journalArticle

Abstract

OBJECTIVE AND IMPORTANCE: Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. Reported hemorrhage rates have ranged from 62 to 91%, and an aggressive clinical course is more likely than a benign clinical course. We describe the first case of a patient with bilateral ethmoidal dural AVFs.CLINICAL PRESENTATION: A 50-year-old man presented with posterior fossa subarachnoid hemorrhage and cerebellar intraparenchymal hemorrhage. Angiography revealed a tentorial AVF and a complex anterior ethmoidal dural AVF.INTERVENTION: The tentorial AVF was treated with preoperative embolization and surgical obliteration. On follow-up angiography, the ethmoidal dural AVF was not considered amenable to embolization. A right modified orbitozygomatic approach was performed and the right-sided fistula was interrupted. Intraoperative angiography revealed obliteration of the right-sided fistula, but a persistent fistula on the left. Further surgical exploration revealed this contralateral anterior ethmoidal dural AVF, which was clip ligated. No residual fistula was noted on intraoperative angiography.CONCLUSION: Anterior ethmoidal dural AVFs may occur bilaterally. Given their complex angiographic appearance, their presence bilaterally may not be readily apparent on preoperative angiography. Intraoperative angiography is crucial to identify a contralateral fistula and to verify that ligation has been curative.

Original languageEnglish (US)
JournalNeurosurgery
Volume57
Issue number4
DOIs
StatePublished - Jan 1 2005
Externally publishedYes

Fingerprint

Central Nervous System Vascular Malformations
Angiography
Fistula
Intracranial Hemorrhages
Arteriovenous Fistula
Hemorrhage
Subarachnoid Hemorrhage
Surgical Instruments
Ligation

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Bilateral ethmoidal dural arteriovenous fistulae : a previously unreported entity: case report. / Deshmukh, Vivek R.; Chang, Steve; Albuquerque, Felipe C.; McDougall, Cameron; Spetzler, Robert F.

In: Neurosurgery, Vol. 57, No. 4, 01.01.2005.

Research output: Contribution to journalArticle

Deshmukh, Vivek R. ; Chang, Steve ; Albuquerque, Felipe C. ; McDougall, Cameron ; Spetzler, Robert F. / Bilateral ethmoidal dural arteriovenous fistulae : a previously unreported entity: case report. In: Neurosurgery. 2005 ; Vol. 57, No. 4.
@article{98b341b523254ea68c36c4a3f315a9b0,
title = "Bilateral ethmoidal dural arteriovenous fistulae: a previously unreported entity: case report.",
abstract = "OBJECTIVE AND IMPORTANCE: Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. Reported hemorrhage rates have ranged from 62 to 91{\%}, and an aggressive clinical course is more likely than a benign clinical course. We describe the first case of a patient with bilateral ethmoidal dural AVFs.CLINICAL PRESENTATION: A 50-year-old man presented with posterior fossa subarachnoid hemorrhage and cerebellar intraparenchymal hemorrhage. Angiography revealed a tentorial AVF and a complex anterior ethmoidal dural AVF.INTERVENTION: The tentorial AVF was treated with preoperative embolization and surgical obliteration. On follow-up angiography, the ethmoidal dural AVF was not considered amenable to embolization. A right modified orbitozygomatic approach was performed and the right-sided fistula was interrupted. Intraoperative angiography revealed obliteration of the right-sided fistula, but a persistent fistula on the left. Further surgical exploration revealed this contralateral anterior ethmoidal dural AVF, which was clip ligated. No residual fistula was noted on intraoperative angiography.CONCLUSION: Anterior ethmoidal dural AVFs may occur bilaterally. Given their complex angiographic appearance, their presence bilaterally may not be readily apparent on preoperative angiography. Intraoperative angiography is crucial to identify a contralateral fistula and to verify that ligation has been curative.",
author = "Deshmukh, {Vivek R.} and Steve Chang and Albuquerque, {Felipe C.} and Cameron McDougall and Spetzler, {Robert F.}",
year = "2005",
month = "1",
day = "1",
doi = "10.1093/neurosurgery/57.4.E809",
language = "English (US)",
volume = "57",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Bilateral ethmoidal dural arteriovenous fistulae

T2 - a previously unreported entity: case report.

AU - Deshmukh, Vivek R.

AU - Chang, Steve

AU - Albuquerque, Felipe C.

AU - McDougall, Cameron

AU - Spetzler, Robert F.

PY - 2005/1/1

Y1 - 2005/1/1

N2 - OBJECTIVE AND IMPORTANCE: Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. Reported hemorrhage rates have ranged from 62 to 91%, and an aggressive clinical course is more likely than a benign clinical course. We describe the first case of a patient with bilateral ethmoidal dural AVFs.CLINICAL PRESENTATION: A 50-year-old man presented with posterior fossa subarachnoid hemorrhage and cerebellar intraparenchymal hemorrhage. Angiography revealed a tentorial AVF and a complex anterior ethmoidal dural AVF.INTERVENTION: The tentorial AVF was treated with preoperative embolization and surgical obliteration. On follow-up angiography, the ethmoidal dural AVF was not considered amenable to embolization. A right modified orbitozygomatic approach was performed and the right-sided fistula was interrupted. Intraoperative angiography revealed obliteration of the right-sided fistula, but a persistent fistula on the left. Further surgical exploration revealed this contralateral anterior ethmoidal dural AVF, which was clip ligated. No residual fistula was noted on intraoperative angiography.CONCLUSION: Anterior ethmoidal dural AVFs may occur bilaterally. Given their complex angiographic appearance, their presence bilaterally may not be readily apparent on preoperative angiography. Intraoperative angiography is crucial to identify a contralateral fistula and to verify that ligation has been curative.

AB - OBJECTIVE AND IMPORTANCE: Ethmoidal dural arteriovenous fistulas (AVFs) are rare intracranial lesions associated with a high risk of intracranial hemorrhage. Reported hemorrhage rates have ranged from 62 to 91%, and an aggressive clinical course is more likely than a benign clinical course. We describe the first case of a patient with bilateral ethmoidal dural AVFs.CLINICAL PRESENTATION: A 50-year-old man presented with posterior fossa subarachnoid hemorrhage and cerebellar intraparenchymal hemorrhage. Angiography revealed a tentorial AVF and a complex anterior ethmoidal dural AVF.INTERVENTION: The tentorial AVF was treated with preoperative embolization and surgical obliteration. On follow-up angiography, the ethmoidal dural AVF was not considered amenable to embolization. A right modified orbitozygomatic approach was performed and the right-sided fistula was interrupted. Intraoperative angiography revealed obliteration of the right-sided fistula, but a persistent fistula on the left. Further surgical exploration revealed this contralateral anterior ethmoidal dural AVF, which was clip ligated. No residual fistula was noted on intraoperative angiography.CONCLUSION: Anterior ethmoidal dural AVFs may occur bilaterally. Given their complex angiographic appearance, their presence bilaterally may not be readily apparent on preoperative angiography. Intraoperative angiography is crucial to identify a contralateral fistula and to verify that ligation has been curative.

UR - http://www.scopus.com/inward/record.url?scp=34447569895&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34447569895&partnerID=8YFLogxK

U2 - 10.1093/neurosurgery/57.4.E809

DO - 10.1093/neurosurgery/57.4.E809

M3 - Article

VL - 57

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 4

ER -