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

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• 作者：Bradley A. Gross ; Karam Moon ; M. Yashar S. Kalani ; Felipe C. Albuquerque ; Cameron G. McDougall ; Peter Nakaji ; Joseph M. Zabramski ; Robert F. Spetzler ; ^{Neuropub@dignityhealth.org" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Anterior fossa ; AVF ; dAVF ; Dural arteriovenous fistula ; Ethmoidal ; Fistula
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：93
• 期：Complete
• 页码：94-99
• 全文大小：2382 K

文摘

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.