Clinical and Anatomic Insights from a Series of Ethmoidal Dural Arteriovenous Fistulas at Barrow Neurological Institute

Bradley A. Gross, Karam Moon, M. Yashar S. Kalani, Felipe C. Albuquerque, Cameron McDougall, Peter Nakaji, Joseph M. Zabramski, Robert F. Spetzler

Research output: Contribution to journalArticle

Abstract

Background Ethmoidal dural arteriovenous fistulas (dAVFs) have a malignant natural history and an anatomy that make endovascular therapy challenging. Their uniqueness begs for stratified analyses, but this has largely been precluded by their rarity. We sought to summarize the anatomic, presentation, treatment approaches, and clinical outcomes of patients with these lesions. Methods We reviewed our prospectively maintained institutional database to identify patients diagnosed with ethmoidal dAVFs from January 1, 2000, to December 31, 2015. We evaluated demographic, presentation, angiographic, treatment, and follow-up data. Results In total, 27 patients with ethmoidal dAVFs underwent endovascular and/or surgical treatment. Mean patient age was 62 years old and there was a male sex predilection (67% men; 2:1 male-female ratio). All dAVFs exhibited direct cortical venous drainage; venous ectasia was present in 59% of cases. Of the dAVFs, 30% drained posteriorly into the basal vein of Rosenthal or the sylvian veins. Embolization with casting of the draining vein was successful in 2 of 9 cases (22%), including 1 successful transvenous case. There were no clinical or permanent complications from embolization; specifically, no patients experienced visual loss after treatment. Surgical treatment with successful dAVF obliteration was carried out in 24 of 24 patients (100%). One patient declined surgical treatment after attempted endovascular embolization. There were no permanent complications after surgical treatment and no cases of wound infection or cerebrospinal fluid leakage. Conclusions Surgical disconnection remains the gold standard in the treatment of ethmoidal dAVFs. Embolization is a consideration for well-selected cases with favorable arterial or venous access anatomy.

Original languageEnglish (US)
Pages (from-to)94-99
Number of pages6
JournalWorld Neurosurgery
Volume93
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Fingerprint

Central Nervous System Vascular Malformations
Cerebral Veins
Therapeutics
Anatomy
Pathologic Dilatations
Wound Infection
Natural History
Drainage
Veins
Demography
Databases

Keywords

  • Anterior fossa
  • AVF
  • dAVF
  • Dural arteriovenous fistula
  • Ethmoidal
  • Fistula

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Clinical and Anatomic Insights from a Series of Ethmoidal Dural Arteriovenous Fistulas at Barrow Neurological Institute. / Gross, Bradley A.; Moon, Karam; Kalani, M. Yashar S.; Albuquerque, Felipe C.; McDougall, Cameron; Nakaji, Peter; Zabramski, Joseph M.; Spetzler, Robert F.

In: World Neurosurgery, Vol. 93, 01.09.2016, p. 94-99.

Research output: Contribution to journalArticle

Gross, Bradley A. ; Moon, Karam ; Kalani, M. Yashar S. ; Albuquerque, Felipe C. ; McDougall, Cameron ; Nakaji, Peter ; Zabramski, Joseph M. ; Spetzler, Robert F. / Clinical and Anatomic Insights from a Series of Ethmoidal Dural Arteriovenous Fistulas at Barrow Neurological Institute. In: World Neurosurgery. 2016 ; Vol. 93. pp. 94-99.
@article{5f1200b3cc2042acb44e000c22008978,
title = "Clinical and Anatomic Insights from a Series of Ethmoidal Dural Arteriovenous Fistulas at Barrow Neurological Institute",
abstract = "Background Ethmoidal dural arteriovenous fistulas (dAVFs) have a malignant natural history and an anatomy that make endovascular therapy challenging. Their uniqueness begs for stratified analyses, but this has largely been precluded by their rarity. We sought to summarize the anatomic, presentation, treatment approaches, and clinical outcomes of patients with these lesions. Methods We reviewed our prospectively maintained institutional database to identify patients diagnosed with ethmoidal dAVFs from January 1, 2000, to December 31, 2015. We evaluated demographic, presentation, angiographic, treatment, and follow-up data. Results In total, 27 patients with ethmoidal dAVFs underwent endovascular and/or surgical treatment. Mean patient age was 62 years old and there was a male sex predilection (67{\%} men; 2:1 male-female ratio). All dAVFs exhibited direct cortical venous drainage; venous ectasia was present in 59{\%} of cases. Of the dAVFs, 30{\%} drained posteriorly into the basal vein of Rosenthal or the sylvian veins. Embolization with casting of the draining vein was successful in 2 of 9 cases (22{\%}), including 1 successful transvenous case. There were no clinical or permanent complications from embolization; specifically, no patients experienced visual loss after treatment. Surgical treatment with successful dAVF obliteration was carried out in 24 of 24 patients (100{\%}). One patient declined surgical treatment after attempted endovascular embolization. There were no permanent complications after surgical treatment and no cases of wound infection or cerebrospinal fluid leakage. Conclusions Surgical disconnection remains the gold standard in the treatment of ethmoidal dAVFs. Embolization is a consideration for well-selected cases with favorable arterial or venous access anatomy.",
keywords = "Anterior fossa, AVF, dAVF, Dural arteriovenous fistula, Ethmoidal, Fistula",
author = "Gross, {Bradley A.} and Karam Moon and Kalani, {M. Yashar S.} and Albuquerque, {Felipe C.} and Cameron McDougall and Peter Nakaji and Zabramski, {Joseph M.} and Spetzler, {Robert F.}",
year = "2016",
month = "9",
day = "1",
doi = "10.1016/j.wneu.2016.05.052",
language = "English (US)",
volume = "93",
pages = "94--99",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Clinical and Anatomic Insights from a Series of Ethmoidal Dural Arteriovenous Fistulas at Barrow Neurological Institute

AU - Gross, Bradley A.

AU - Moon, Karam

AU - Kalani, M. Yashar S.

AU - Albuquerque, Felipe C.

AU - McDougall, Cameron

AU - Nakaji, Peter

AU - Zabramski, Joseph M.

AU - Spetzler, Robert F.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background Ethmoidal dural arteriovenous fistulas (dAVFs) have a malignant natural history and an anatomy that make endovascular therapy challenging. Their uniqueness begs for stratified analyses, but this has largely been precluded by their rarity. We sought to summarize the anatomic, presentation, treatment approaches, and clinical outcomes of patients with these lesions. Methods We reviewed our prospectively maintained institutional database to identify patients diagnosed with ethmoidal dAVFs from January 1, 2000, to December 31, 2015. We evaluated demographic, presentation, angiographic, treatment, and follow-up data. Results In total, 27 patients with ethmoidal dAVFs underwent endovascular and/or surgical treatment. Mean patient age was 62 years old and there was a male sex predilection (67% men; 2:1 male-female ratio). All dAVFs exhibited direct cortical venous drainage; venous ectasia was present in 59% of cases. Of the dAVFs, 30% drained posteriorly into the basal vein of Rosenthal or the sylvian veins. Embolization with casting of the draining vein was successful in 2 of 9 cases (22%), including 1 successful transvenous case. There were no clinical or permanent complications from embolization; specifically, no patients experienced visual loss after treatment. Surgical treatment with successful dAVF obliteration was carried out in 24 of 24 patients (100%). One patient declined surgical treatment after attempted endovascular embolization. There were no permanent complications after surgical treatment and no cases of wound infection or cerebrospinal fluid leakage. Conclusions Surgical disconnection remains the gold standard in the treatment of ethmoidal dAVFs. Embolization is a consideration for well-selected cases with favorable arterial or venous access anatomy.

AB - Background Ethmoidal dural arteriovenous fistulas (dAVFs) have a malignant natural history and an anatomy that make endovascular therapy challenging. Their uniqueness begs for stratified analyses, but this has largely been precluded by their rarity. We sought to summarize the anatomic, presentation, treatment approaches, and clinical outcomes of patients with these lesions. Methods We reviewed our prospectively maintained institutional database to identify patients diagnosed with ethmoidal dAVFs from January 1, 2000, to December 31, 2015. We evaluated demographic, presentation, angiographic, treatment, and follow-up data. Results In total, 27 patients with ethmoidal dAVFs underwent endovascular and/or surgical treatment. Mean patient age was 62 years old and there was a male sex predilection (67% men; 2:1 male-female ratio). All dAVFs exhibited direct cortical venous drainage; venous ectasia was present in 59% of cases. Of the dAVFs, 30% drained posteriorly into the basal vein of Rosenthal or the sylvian veins. Embolization with casting of the draining vein was successful in 2 of 9 cases (22%), including 1 successful transvenous case. There were no clinical or permanent complications from embolization; specifically, no patients experienced visual loss after treatment. Surgical treatment with successful dAVF obliteration was carried out in 24 of 24 patients (100%). One patient declined surgical treatment after attempted endovascular embolization. There were no permanent complications after surgical treatment and no cases of wound infection or cerebrospinal fluid leakage. Conclusions Surgical disconnection remains the gold standard in the treatment of ethmoidal dAVFs. Embolization is a consideration for well-selected cases with favorable arterial or venous access anatomy.

KW - Anterior fossa

KW - AVF

KW - dAVF

KW - Dural arteriovenous fistula

KW - Ethmoidal

KW - Fistula

UR - http://www.scopus.com/inward/record.url?scp=84976334210&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84976334210&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2016.05.052

DO - 10.1016/j.wneu.2016.05.052

M3 - Article

C2 - 27241099

AN - SCOPUS:84976334210

VL - 93

SP - 94

EP - 99

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -