硬脑膜动静脉瘘病因及血管内治疗的临床研究
摘要
硬脑膜动静脉瘘(dural arteriovenous fistula, DAVF)指发生于硬脑膜及其附属物(静脉窦、大脑镰、小脑幕等)的动脉与静脉直接沟通的异常性血管病变,占颅内动静脉畸形的10%～15%。DAVF病因及发病机制并明,且血管构筑复杂,是目前较为难治的脑血管疾病,其发展的结局可能为致命性的颅内出血及脑疝。为改善DAVF的预防及治疗,本文将着重探讨DAVF的病因及其恶性进展的危险因素,并探讨其治疗措施及评价疗效。
第一章
硬脑膜动静脉瘘发病危险因素分析
研究背景
DAVF病因未明,可能与影响血管生理、静脉窦解剖结构或静脉窦血流动力学等因素有关,尽管文献报道DAVF与静脉窦血栓形成、外伤、脑肿瘤、雌性激素水平下降、高龄等因素并存,但其多限于临床病例报道而缺少系统分析,因而有待进一步研究。
目的
探讨DAVF发病的危险因素。
方法
DAVF病例组来自近10年南方医科大学珠江医院神经外科收治的146例患者,男56例,女90例,年龄14-76岁,对照组来自同期怀疑DAVF但脑血管造影正常的134例对照病例,男68例,女66例；年龄2-71岁。分析比较两组间年龄、性别、高血压、高血脂、高血糖及吸烟、肿瘤、外伤、横窦-乙状窦发育不对称、妊娠,静脉窦血栓等因素的差异,并应用Logistic回归分析方法分析上述因素,总结DAVF发病的危险因素。
结果
病例组及对照组的年龄(42.4±15.7岁,35.3±18.1岁；P=0.000),女性患者(61.6%,49.3%,P=0.037),静脉窦血栓(15.8%,1.5%；P=0.000),头外伤(20.5%,4.5%；P=0.000),横-乙状窦不对称(83.6%,65.7%；P=0.001)等因素存在显著性差异；Logistic回归分析提示DAVF发病的危险因素为：女性(OR2.605,95%C.I.1.467-4.626,P=0.001),年龄(OR1.039,95%C.I.1.021～1.057,P=0.000),静脉窦血栓(OR17.289,95%C.I.3.633-82.272,P=0.000),头外伤(OR13.618,95%C.I.4.841-38.307,P=0.000),横窦-乙状窦发育不对称(OR3.069,95%C.I.1.599-5.892,P=0.001)。
结论
高龄,女性,静脉窦血栓,头外伤及横窦-乙状窦发育不对称者更易发生DAVF。
第二章进展性DAVF的血管构筑特点及危险因素分析
研究背景
进展型DAVF (aggressive DAVF, aDAVF)较易发展为静脉性脑梗塞或致命性颅内出血。其进展原因可能与DAVF的血管构筑学特征(引流模式、部位、供血类型)及横窦系统对DAVF引流的影响等因素有关,目前文献对aDAVF的血管构筑特征报道不足,而对aDAVF进展原因的报道也多限于皮层静脉返流而忽略其它因素的影响,因此,本章主要探讨aDAVF的血管构筑特点及aDAVF形成的危险因素。
目的
探讨aDAVF的血管构筑特征及aDAVF形成的危险因素。
方法
回顾分析近10年南方医科大学珠江医院神经外科收治的146例DAVF患者,男56例,女90例,年龄14-76岁。分析比较其中aDAVF及良性DAVF(benign DAVF, bDAVF)两组间年龄、性别、血管影像构筑学特征(引流模式、部位、供血类型)及优势横窦-DAVF侧别关系(横窦对称,DAVF与优势横窦同侧,DAVF与非优势横窦同侧)；并应用Logistic回归分析方法分析上述因素,总结其中aDAVF发病的危险因素。
结果
bDAVF组及aDAVF组如下变量存在统计学差异：年龄(40.3±16.5岁,46.7±12.9岁;P=0.021),DAVF与优势横窦的引流关系[双侧横窦对称引流28(28.6%),28(58.3%)；DAVF由优势横窦引流20(20.4%),12(25.0%)；DAVF由非优势横窦引流50(51.0%),8(16.7%)；P=0.000],DAVF部位[海绵窦78(79.6%),14(29.2%)；大窦区8(8.2%),22(45.8%)；非窦区12(12.2%),12(25.0%)；P=0.000],供血系统[单系统供血36(36.7%),8(16.7%)；多系统供血62(63.3%),40(83.3%)P=0.013],Cognard分型[Ⅰ12(12.2%),6(12.5%), Ⅱa48(49.0%),10(20.8%), Ⅱb16(16.3%),2(4.2%); Ⅱa+Ⅱb18(18.4%),26(54.2%)；Ⅲ2(2.0%),2(4.2%)；Ⅳ2(2.0%),2(4.2%)；P=0.000]。Logistic回归分析提示aDAVF发病的危险因素为：高龄(OR1.072,95%C.I.1.072～1.119,P=0.001),大窦区(横-乙状窦,上矢状窦)(OR16.332,95%C.I.4.437～60.114,P=0.000),非窦区(OR27.482,95%C.I.3.862～195.552,P=0..001),多系统供血(OR8.830,95%C.I.1.961～39.757,P=0.005),CognardⅡa+b (OR5.448,95%C. I.1.047-28.351, P=0.044); aDAVF发病的保护因素为：DAVF与非优势横窦同侧(OR0.168,95%C.I..045～.635,P=0.009)。
结论
aDAVF组年龄高于bDAVF组；较bDAVF,aDAVF血管构筑存在如下特征：在DAVF与优势横窦的关系中,aDAVF组以双侧横窦对称引流为主,bDAVF组以DAVF由非优势横窦引流为主；aDAVF组部位以大窦区(横-乙状窦,上矢状窦)为主,bDAVF组则以海绵窦为主;aDAVF组供血系统以多系统为主,bDAVF组则以单供血系统为主；aDAVF组引流方式以Cognard Ⅱa+Ⅱb为主,bDAVF组则以CognardⅡa为主。
高龄,位于大窦区(横-乙状窦,上矢状窦)或非窦区,多系统供血,Cognard Ⅱa+b型DAVF患者易发展为aDAVF; DAVF与非优势横窦同侧的患者不易发展为aDAVF.
第三章硬脑膜动静脉瘘的血管内栓塞治疗
研究背景
介入栓塞为DAVF的主要治疗方式,经静脉途径栓塞已为主要的治疗途径,但其以牺牲相应静脉窦为基础,NBCA作为一种液态栓塞剂使经动脉途径治疗得以改进,但其粘附性的缺点限制了其应用及疗效。近期Onyx作为一种非粘附性液态栓塞剂,已广泛应用于脑动静脉畸形的栓塞治疗并已尝试应用于治疗DAVF,但其在不同部位DAVF(海绵窦区,非海绵窦区-大窦区及非窦区)的治疗途径及疗效,尚缺少经验及报道。
目的
探讨Onyx在不同部位DAVF(海绵窦区,大窦区及非窦区)介入治疗中的入路途径、疗效及其较NBCA的优势。
方法
DAVF病例来自近10年于南方医科大学珠江医院神经外科行NBCA或Onyx介入治疗的患者,共79例,男42例,女37例,年龄13～64岁,平均34.3±15.7岁。回顾分析其住院记录、手术记录及影像学资料,分析比较Onyx与NBCA治疗入路及临床疗效的差异。
结果
NBCA及Onyx组的两组的即时影像结果示完全闭塞率分别为23.8%及75.7%,次全闭塞率为21.4%及24.3%,不全闭塞率为54.8%及0%,P=.000；临床及影像学随访3-36月,平均11.1±7.8月,NBCA及Onyx组的临床随访结果为治愈36.6%及76.9%,好转17.1%及7.7%,无效或复发为46.3%及15.4%,P=.005；两组的影像学随访示完全闭塞30.0%及70.0%,次全闭塞16.7%及10.0%,无效或复发53.3%及20.0%,P=.019；两组的并发症发生率分别为9.5%及40.5%,P=.001；两组的栓塞入路途径分别为静脉途径9.5%及40.5%,动脉途径85.7%及59.5%,静脉+动脉途径4.8%及.0%,P=.003；其中Onyx组中在海绵窦区硬脑膜动静脉瘘(cavernous sinus dural arteriovenous fistula, csDAVF)栓塞治疗时全部经静脉途径(其中经岩下窦13/15例,眼上静脉2/15例),而在非海绵窦区DAVF (non-cavernous sinus dural arteriovenous fistula, ncsDAVF)的栓塞治疗中则全部经动脉途径,其中经脑膜中动脉9/22例,枕动脉2/22例,耳后动脉8/22,多动脉入路3/22。
结论
在DAVF的治疗中,Onyx的总体临床治愈率优于NBCA,但需注意并发症的防治,对csDAVF,静脉途径是主要的栓塞入路,并以岩下窦多见,而对ncsDAVF,经动脉入路为主要的栓塞入路,并以脑膜中动脉及耳后动脉多见。
Dural arteriovenous fistula (dural arteriovenous fistula, DAVF) is a vascular disease with directed arteries and veins communication, involving in the dura and its appendages (venous sinus, cerebral falx and tentorium of cerebellum), which accounting for10%-15%of intracranial arteriovenous malformation. The etiology and pathogenesis for DAVF are not clear yet, and it may develop into fatal intracranial bleeding or cerebral hernia in the end. Furthermore, because of the complex angioarchitecture, it is difficult to treat a DAVF. Therefore, we mainly focus on the risk factors for the generation and aggressive development of the DAVF, as well as evaluating its treatment method and the curative effect.
The First Chapter
Analysis of Risk Factors of Dural Arteriovenous Fistula
Background
It is still unclear that the cause for the generation of dural arteriovenous fistula (DAVF); there may be relation with factors as follows:factors affecting blood vessel physiology, sinus venosus anatomic structure, and the change of haemodynamics. Though literature reported that DAVF usually coexists with the sinus thrombosis, trauma, brain tumors, the reducing of female hormone, age and so on, but till now they are limited in clinical case report but lack of system analysis.
Objective
To study the risk factors for the DAVF
Methods
146patients in DAVF group were selected from southern medical university zhujiang hospital in the near10years, male56cases, female90cases, age range from14to76years, and134cases in control group with a normal cerebral angiography in the same period, male68cases, female66cases, age range from2to71years. The differences between the two groups were analyzed, including age, sex, hypertension, hyperlipemia, hypertension, smoking, tumor, trauma, transverses-sigmoid sinus asymmetry, pregnancy and sinus thrombosis, and then the logistic regression analysis method was used to analyze the above factors which having significant difference to find the risk factors for the DAVF.
Results
There are significant differences between the patient group and the control group in age (42.4±15.7years,35.3±18.1years; P=0.000), female (61.6%,49.3%, P=0.037), sinus thrombosis (15.8%,1.5%; P=0.000), head trauma (20.5%,4.5%; P=0.000), transverses-sigmoid sinus asymmetry (83.6%,65.7%; P=0.001).And the risk factor for DAVF are as following:female (OR2.605,95%C.I.1.467±4.626, P=0.001), age (OR1.039,95%C.I.1.021-1.057, P=0.000), sinus thrombosis (OR17.289,95%C.I.3.633-82.272, P=0.000), head trauma(OR13.618,95%C.I.4.841-38.307, P=0.000), and transverses-sigmoid sinus asymmetry (OR3.069,95%C.I.1.599-5.892, P=0.001)
Conclusion
Patients with elder age, female, sinus thrombosis, head trauma or transverses-sigmoid sinus asymmetry are more easy to catch a DAVF disease.
The Second Chapter
Angioarchitecture Characteristic and the Risk Factors of Aggressive DAVF
Background
Aggressive DAVF (aDAVF) may develop into venous cerebral infarction or fatal intracranial hemorrhage, there maybe relation with angioarchitecture (drainage mode, location, blood-supply type,) and the relation of the type of transverse sinus and the side of DAVF, but literature about DAVF's angioarchitecture characteristic is limited and the reason of aDAVF is considered mainly as the result of cortex vein reflux at present, but ignoring other factors. So this chapter mainly focuses on the angioarchitecture characteristic as well as systems analysis of the risk factors for the aDAVF.
Objective
To study the angioarchitecture characteristic and analyze the risk factor of aDAVF
Methods
146cases with DAVF from Southern Medical University Zhujiang Hospital in the near10years were reviewed, including male56cases, female90cases, and age range from14to76years. Patients were divided into aDAVF group and bDAVF (benign DAVF) group, and the differences between the two groups were analyzed, including demographic characteristics, angiogram angioarchitecture characteristic (drainage mode, location, and type of blood supply) and transverse sinus type-DAVF side (transverse sinus symmetry, DAVF at the same side of the main transverse sinus and DAVF at the same side of the non-main transverse sinus), then the logistic regression analysis was used to analyze the above factors which having significant difference for the risk factors of aDAVF.
Results
The significant differences between the bDAVF of control group and the aDAVF of patient group were respectively as follows:age (40.3±16.5岁,46.7±12.9%岁; P=0.021), transverse sinus type-DAVF side[transverse sinus symmetry28(28.6%),28(58.3%); DAVF at the same side of the main transverse sinus20(20.4%),12(25.0%); and DAVF at the same side of the non-main transverse sinus50(51.0%),8(16.7%); P=0.000], DAVF location [cavernous sinus78(79.6%),14(29.2%); large sinus8(8.2%),22(45.8%); non-sinus12(12.2%),12(25.0%); P=0.000],blood-supply system [single blood-supply system36(36.7%),8(16.7%); multi-blood-supply system62(63.3%),40(83.3%) P=0.013], Cognard type[I12(12.2%),6(12.5%), IIa48(49.0%),10(20.8%), Ⅱb16(16.3%),2(4.2%); Ⅱa+Ⅱb18(18.4%),26(54.2%); Ⅲ2(2.0%),2(4.2%); Ⅳ2(2.0%),2(4.2%); P=0.000].
The risk factors for aDAVF were as follows:age (OR1.094,95%C.I.1.039-1.153, P=0.001), large sinus region (transver-sigmoid and superior sagittal sinus)(OR25.369,95%C.I.3.463-185.840, P=0.001), multi-blood-supply system (OR8.830,95%C.I.1.961-39.757, P=0.005), Cognardlla+b (OR13.756,95%C.I.1.934-97.868, P=0.009); and the protection factor of aDAVF was DAVF at the same side of the non-main transverse sinus (OR.108,95%C.I..022-531, P=0.006).
Conclusion
The age of aDAVF group is high than bDAVF group; Compared with bDAVF, the angioarchitecture characteristics are as follows:Transverse sinus symmetry is the main type in aDAVF group, vs. DAVF at the same side of the non-main transverse sinus is the main type of bDAVF; aDAVF is more prone to involved in large sinus region, vs bDAVF mainly involved in cavernous sinus; The multi-blood-supply system is the main types of blood supply for aDAVF, vs the single-blood-supply system is the main types of blood supply for bDAVF; The main drainage system is Cognard Ⅱa+Ⅱb in aDAVF vs Cognard Ⅱ a in bDAVF.
DAVFs with the following factor may easy develop into aDAVF, including edler age, locating in the big sinus area (transver-sigmoid and superior sagittal sinus) and non-sinus, multi-blood-supply system, and CognardⅡa+b type; but DAVF at the same side of the non-main transverse sinus may not prone to develop into aDAVF.
The Third Chapter Endovascular Treatment of Dural Arteriovenous Fistula
Background
Intervention embolization for DAVF has been the main treatment, and transvenous approach has been the primary treatment pathway, but it will lead to the corresponding sinus being sacrificed through such an approach. Though NBCA, which has be as a liquid embolic agents, could be used for DAVF embolization through the trans-arterious approach, but the application and curative effect were confined by its adhesion shortcomings. Recent, Onyx has emerged as a kind of non-adhesion of liquid embolic agents, which has been widely used in the brain arteriovenous malformation, and has been tried to be used for DAVF embolization. But the treatment approach and curative effect of using Onyx in different location of DAVF (cavernous sinus area, non-cavernous sinus area-big sinus area and the non-sinus area), are still lack of details.
Objective
To study the embolization approach for different location of DAVF (the cavernous sinus area, big sinus area and the non-sinus area) by using Onyx embolization, as well as evaluate its curative effect and advantage comparing with using NBCA embolization.
Methods
cases with DAVF were selected from department of neurosurgery, southern medical university zhujiang hospital in the near10years, for which NBCA or Onyx embolization was performed, including male42cases, female37cases, and a total of79cases, age range from13to64years old, and a mean of34.3+15.7years old. The hospitalization record, endovascular treatment records, and angiography imaging were retrospectively analyzed to find the differences in treatment approach and curative effect between Onyx and NBCA embolization.
Results
Immediate angiography showed that the total occlusion rate in NBCA and Onyx group was23.8%and75.7%, near-total occlusion rate was21.4%and24.3%occlusion, uncompleted occlusion rate is54.8%and0%, P=.000, respectively; Clinical and radiographic follow-up were performed in3-36months (mean11.1±7.8months), clinical follow-up in NBCA group and Onyx group showed that the cure rate was36.6%and76.9%, improvement rate was17.1%and7.7%, invalid or recurrence rate was46.3%and15.4%, respectively, P=.005; Angiography follow-up showed that the total occlusion rate in NBCA and Onyx group was30.0%and70.0%, near-total occlusion rate was16.7%and10.0%, uncompleted occlusion rate is53.3%and20.0%, respectively, P=.019; Respectively, complication rate in the two groups was9.5%and40.5%, P=.005; Transvenous approach in the two groups was9.5%and40.5%, transarterial way was85.7%and59.5%, transvenous+transarterial way was4.8%and0%, P=003; in addition, transvenous approach was successfully applied in all csDAVF by using Onyx embolization (including via inferior petrosal sinus13/15cases, superior ophthalmic vein2/15cases), while transarterial way was performed in all ncsDAVF (including via the meningeal artery in9/22cases, pillow artery2/22cases, ear hind artery8/22cases, and multi-artery3/22cases).
Conclusion
For treating DAVF, curative effect of Onyx is better than that of NBCA, but need to pay attention to prevent and control the complications. When using Onyx, for csDAVF, transvenous way is the main embolization approach and the trans-inferior petrosal sinus is being used mostly, but for ncsDAVF, transarterial approach is the main treatment approach, and the trans-meninges artery and the posterior auricular artery are used mostly.
第一章
硬脑膜动静脉瘘发病危险因素分析
研究背景
DAVF病因未明,可能与影响血管生理、静脉窦解剖结构或静脉窦血流动力学等因素有关,尽管文献报道DAVF与静脉窦血栓形成、外伤、脑肿瘤、雌性激素水平下降、高龄等因素并存,但其多限于临床病例报道而缺少系统分析,因而有待进一步研究。
目的
探讨DAVF发病的危险因素。
方法
DAVF病例组来自近10年南方医科大学珠江医院神经外科收治的146例患者,男56例,女90例,年龄14-76岁,对照组来自同期怀疑DAVF但脑血管造影正常的134例对照病例,男68例,女66例；年龄2-71岁。分析比较两组间年龄、性别、高血压、高血脂、高血糖及吸烟、肿瘤、外伤、横窦-乙状窦发育不对称、妊娠,静脉窦血栓等因素的差异,并应用Logistic回归分析方法分析上述因素,总结DAVF发病的危险因素。
结果
病例组及对照组的年龄(42.4±15.7岁,35.3±18.1岁；P=0.000),女性患者(61.6%,49.3%,P=0.037),静脉窦血栓(15.8%,1.5%；P=0.000),头外伤(20.5%,4.5%；P=0.000),横-乙状窦不对称(83.6%,65.7%；P=0.001)等因素存在显著性差异；Logistic回归分析提示DAVF发病的危险因素为：女性(OR2.605,95%C.I.1.467-4.626,P=0.001),年龄(OR1.039,95%C.I.1.021～1.057,P=0.000),静脉窦血栓(OR17.289,95%C.I.3.633-82.272,P=0.000),头外伤(OR13.618,95%C.I.4.841-38.307,P=0.000),横窦-乙状窦发育不对称(OR3.069,95%C.I.1.599-5.892,P=0.001)。
结论
高龄,女性,静脉窦血栓,头外伤及横窦-乙状窦发育不对称者更易发生DAVF。
第二章进展性DAVF的血管构筑特点及危险因素分析
研究背景
进展型DAVF (aggressive DAVF, aDAVF)较易发展为静脉性脑梗塞或致命性颅内出血。其进展原因可能与DAVF的血管构筑学特征(引流模式、部位、供血类型)及横窦系统对DAVF引流的影响等因素有关,目前文献对aDAVF的血管构筑特征报道不足,而对aDAVF进展原因的报道也多限于皮层静脉返流而忽略其它因素的影响,因此,本章主要探讨aDAVF的血管构筑特点及aDAVF形成的危险因素。
目的
探讨aDAVF的血管构筑特征及aDAVF形成的危险因素。
方法
回顾分析近10年南方医科大学珠江医院神经外科收治的146例DAVF患者,男56例,女90例,年龄14-76岁。分析比较其中aDAVF及良性DAVF(benign DAVF, bDAVF)两组间年龄、性别、血管影像构筑学特征(引流模式、部位、供血类型)及优势横窦-DAVF侧别关系(横窦对称,DAVF与优势横窦同侧,DAVF与非优势横窦同侧)；并应用Logistic回归分析方法分析上述因素,总结其中aDAVF发病的危险因素。
结果
bDAVF组及aDAVF组如下变量存在统计学差异：年龄(40.3±16.5岁,46.7±12.9岁;P=0.021),DAVF与优势横窦的引流关系[双侧横窦对称引流28(28.6%),28(58.3%)；DAVF由优势横窦引流20(20.4%),12(25.0%)；DAVF由非优势横窦引流50(51.0%),8(16.7%)；P=0.000],DAVF部位[海绵窦78(79.6%),14(29.2%)；大窦区8(8.2%),22(45.8%)；非窦区12(12.2%),12(25.0%)；P=0.000],供血系统[单系统供血36(36.7%),8(16.7%)；多系统供血62(63.3%),40(83.3%)P=0.013],Cognard分型[Ⅰ12(12.2%),6(12.5%), Ⅱa48(49.0%),10(20.8%), Ⅱb16(16.3%),2(4.2%); Ⅱa+Ⅱb18(18.4%),26(54.2%)；Ⅲ2(2.0%),2(4.2%)；Ⅳ2(2.0%),2(4.2%)；P=0.000]。Logistic回归分析提示aDAVF发病的危险因素为：高龄(OR1.072,95%C.I.1.072～1.119,P=0.001),大窦区(横-乙状窦,上矢状窦)(OR16.332,95%C.I.4.437～60.114,P=0.000),非窦区(OR27.482,95%C.I.3.862～195.552,P=0..001),多系统供血(OR8.830,95%C.I.1.961～39.757,P=0.005),CognardⅡa+b (OR5.448,95%C. I.1.047-28.351, P=0.044); aDAVF发病的保护因素为：DAVF与非优势横窦同侧(OR0.168,95%C.I..045～.635,P=0.009)。
结论
aDAVF组年龄高于bDAVF组；较bDAVF,aDAVF血管构筑存在如下特征：在DAVF与优势横窦的关系中,aDAVF组以双侧横窦对称引流为主,bDAVF组以DAVF由非优势横窦引流为主；aDAVF组部位以大窦区(横-乙状窦,上矢状窦)为主,bDAVF组则以海绵窦为主;aDAVF组供血系统以多系统为主,bDAVF组则以单供血系统为主；aDAVF组引流方式以Cognard Ⅱa+Ⅱb为主,bDAVF组则以CognardⅡa为主。
高龄,位于大窦区(横-乙状窦,上矢状窦)或非窦区,多系统供血,Cognard Ⅱa+b型DAVF患者易发展为aDAVF; DAVF与非优势横窦同侧的患者不易发展为aDAVF.
第三章硬脑膜动静脉瘘的血管内栓塞治疗
研究背景
介入栓塞为DAVF的主要治疗方式,经静脉途径栓塞已为主要的治疗途径,但其以牺牲相应静脉窦为基础,NBCA作为一种液态栓塞剂使经动脉途径治疗得以改进,但其粘附性的缺点限制了其应用及疗效。近期Onyx作为一种非粘附性液态栓塞剂,已广泛应用于脑动静脉畸形的栓塞治疗并已尝试应用于治疗DAVF,但其在不同部位DAVF(海绵窦区,非海绵窦区-大窦区及非窦区)的治疗途径及疗效,尚缺少经验及报道。
目的
探讨Onyx在不同部位DAVF(海绵窦区,大窦区及非窦区)介入治疗中的入路途径、疗效及其较NBCA的优势。
方法
DAVF病例来自近10年于南方医科大学珠江医院神经外科行NBCA或Onyx介入治疗的患者,共79例,男42例,女37例,年龄13～64岁,平均34.3±15.7岁。回顾分析其住院记录、手术记录及影像学资料,分析比较Onyx与NBCA治疗入路及临床疗效的差异。
结果
NBCA及Onyx组的两组的即时影像结果示完全闭塞率分别为23.8%及75.7%,次全闭塞率为21.4%及24.3%,不全闭塞率为54.8%及0%,P=.000；临床及影像学随访3-36月,平均11.1±7.8月,NBCA及Onyx组的临床随访结果为治愈36.6%及76.9%,好转17.1%及7.7%,无效或复发为46.3%及15.4%,P=.005；两组的影像学随访示完全闭塞30.0%及70.0%,次全闭塞16.7%及10.0%,无效或复发53.3%及20.0%,P=.019；两组的并发症发生率分别为9.5%及40.5%,P=.001；两组的栓塞入路途径分别为静脉途径9.5%及40.5%,动脉途径85.7%及59.5%,静脉+动脉途径4.8%及.0%,P=.003；其中Onyx组中在海绵窦区硬脑膜动静脉瘘(cavernous sinus dural arteriovenous fistula, csDAVF)栓塞治疗时全部经静脉途径(其中经岩下窦13/15例,眼上静脉2/15例),而在非海绵窦区DAVF (non-cavernous sinus dural arteriovenous fistula, ncsDAVF)的栓塞治疗中则全部经动脉途径,其中经脑膜中动脉9/22例,枕动脉2/22例,耳后动脉8/22,多动脉入路3/22。
结论
在DAVF的治疗中,Onyx的总体临床治愈率优于NBCA,但需注意并发症的防治,对csDAVF,静脉途径是主要的栓塞入路,并以岩下窦多见,而对ncsDAVF,经动脉入路为主要的栓塞入路,并以脑膜中动脉及耳后动脉多见。
Dural arteriovenous fistula (dural arteriovenous fistula, DAVF) is a vascular disease with directed arteries and veins communication, involving in the dura and its appendages (venous sinus, cerebral falx and tentorium of cerebellum), which accounting for10%-15%of intracranial arteriovenous malformation. The etiology and pathogenesis for DAVF are not clear yet, and it may develop into fatal intracranial bleeding or cerebral hernia in the end. Furthermore, because of the complex angioarchitecture, it is difficult to treat a DAVF. Therefore, we mainly focus on the risk factors for the generation and aggressive development of the DAVF, as well as evaluating its treatment method and the curative effect.
The First Chapter
Analysis of Risk Factors of Dural Arteriovenous Fistula
Background
It is still unclear that the cause for the generation of dural arteriovenous fistula (DAVF); there may be relation with factors as follows:factors affecting blood vessel physiology, sinus venosus anatomic structure, and the change of haemodynamics. Though literature reported that DAVF usually coexists with the sinus thrombosis, trauma, brain tumors, the reducing of female hormone, age and so on, but till now they are limited in clinical case report but lack of system analysis.
Objective
To study the risk factors for the DAVF
Methods
146patients in DAVF group were selected from southern medical university zhujiang hospital in the near10years, male56cases, female90cases, age range from14to76years, and134cases in control group with a normal cerebral angiography in the same period, male68cases, female66cases, age range from2to71years. The differences between the two groups were analyzed, including age, sex, hypertension, hyperlipemia, hypertension, smoking, tumor, trauma, transverses-sigmoid sinus asymmetry, pregnancy and sinus thrombosis, and then the logistic regression analysis method was used to analyze the above factors which having significant difference to find the risk factors for the DAVF.
Results
There are significant differences between the patient group and the control group in age (42.4±15.7years,35.3±18.1years; P=0.000), female (61.6%,49.3%, P=0.037), sinus thrombosis (15.8%,1.5%; P=0.000), head trauma (20.5%,4.5%; P=0.000), transverses-sigmoid sinus asymmetry (83.6%,65.7%; P=0.001).And the risk factor for DAVF are as following:female (OR2.605,95%C.I.1.467±4.626, P=0.001), age (OR1.039,95%C.I.1.021-1.057, P=0.000), sinus thrombosis (OR17.289,95%C.I.3.633-82.272, P=0.000), head trauma(OR13.618,95%C.I.4.841-38.307, P=0.000), and transverses-sigmoid sinus asymmetry (OR3.069,95%C.I.1.599-5.892, P=0.001)
Conclusion
Patients with elder age, female, sinus thrombosis, head trauma or transverses-sigmoid sinus asymmetry are more easy to catch a DAVF disease.
The Second Chapter
Angioarchitecture Characteristic and the Risk Factors of Aggressive DAVF
Background
Aggressive DAVF (aDAVF) may develop into venous cerebral infarction or fatal intracranial hemorrhage, there maybe relation with angioarchitecture (drainage mode, location, blood-supply type,) and the relation of the type of transverse sinus and the side of DAVF, but literature about DAVF's angioarchitecture characteristic is limited and the reason of aDAVF is considered mainly as the result of cortex vein reflux at present, but ignoring other factors. So this chapter mainly focuses on the angioarchitecture characteristic as well as systems analysis of the risk factors for the aDAVF.
Objective
To study the angioarchitecture characteristic and analyze the risk factor of aDAVF
Methods
146cases with DAVF from Southern Medical University Zhujiang Hospital in the near10years were reviewed, including male56cases, female90cases, and age range from14to76years. Patients were divided into aDAVF group and bDAVF (benign DAVF) group, and the differences between the two groups were analyzed, including demographic characteristics, angiogram angioarchitecture characteristic (drainage mode, location, and type of blood supply) and transverse sinus type-DAVF side (transverse sinus symmetry, DAVF at the same side of the main transverse sinus and DAVF at the same side of the non-main transverse sinus), then the logistic regression analysis was used to analyze the above factors which having significant difference for the risk factors of aDAVF.
Results
The significant differences between the bDAVF of control group and the aDAVF of patient group were respectively as follows:age (40.3±16.5岁,46.7±12.9%岁; P=0.021), transverse sinus type-DAVF side[transverse sinus symmetry28(28.6%),28(58.3%); DAVF at the same side of the main transverse sinus20(20.4%),12(25.0%); and DAVF at the same side of the non-main transverse sinus50(51.0%),8(16.7%); P=0.000], DAVF location [cavernous sinus78(79.6%),14(29.2%); large sinus8(8.2%),22(45.8%); non-sinus12(12.2%),12(25.0%); P=0.000],blood-supply system [single blood-supply system36(36.7%),8(16.7%); multi-blood-supply system62(63.3%),40(83.3%) P=0.013], Cognard type[I12(12.2%),6(12.5%), IIa48(49.0%),10(20.8%), Ⅱb16(16.3%),2(4.2%); Ⅱa+Ⅱb18(18.4%),26(54.2%); Ⅲ2(2.0%),2(4.2%); Ⅳ2(2.0%),2(4.2%); P=0.000].
The risk factors for aDAVF were as follows:age (OR1.094,95%C.I.1.039-1.153, P=0.001), large sinus region (transver-sigmoid and superior sagittal sinus)(OR25.369,95%C.I.3.463-185.840, P=0.001), multi-blood-supply system (OR8.830,95%C.I.1.961-39.757, P=0.005), Cognardlla+b (OR13.756,95%C.I.1.934-97.868, P=0.009); and the protection factor of aDAVF was DAVF at the same side of the non-main transverse sinus (OR.108,95%C.I..022-531, P=0.006).
Conclusion
The age of aDAVF group is high than bDAVF group; Compared with bDAVF, the angioarchitecture characteristics are as follows:Transverse sinus symmetry is the main type in aDAVF group, vs. DAVF at the same side of the non-main transverse sinus is the main type of bDAVF; aDAVF is more prone to involved in large sinus region, vs bDAVF mainly involved in cavernous sinus; The multi-blood-supply system is the main types of blood supply for aDAVF, vs the single-blood-supply system is the main types of blood supply for bDAVF; The main drainage system is Cognard Ⅱa+Ⅱb in aDAVF vs Cognard Ⅱ a in bDAVF.
DAVFs with the following factor may easy develop into aDAVF, including edler age, locating in the big sinus area (transver-sigmoid and superior sagittal sinus) and non-sinus, multi-blood-supply system, and CognardⅡa+b type; but DAVF at the same side of the non-main transverse sinus may not prone to develop into aDAVF.
The Third Chapter Endovascular Treatment of Dural Arteriovenous Fistula
Background
Intervention embolization for DAVF has been the main treatment, and transvenous approach has been the primary treatment pathway, but it will lead to the corresponding sinus being sacrificed through such an approach. Though NBCA, which has be as a liquid embolic agents, could be used for DAVF embolization through the trans-arterious approach, but the application and curative effect were confined by its adhesion shortcomings. Recent, Onyx has emerged as a kind of non-adhesion of liquid embolic agents, which has been widely used in the brain arteriovenous malformation, and has been tried to be used for DAVF embolization. But the treatment approach and curative effect of using Onyx in different location of DAVF (cavernous sinus area, non-cavernous sinus area-big sinus area and the non-sinus area), are still lack of details.
Objective
To study the embolization approach for different location of DAVF (the cavernous sinus area, big sinus area and the non-sinus area) by using Onyx embolization, as well as evaluate its curative effect and advantage comparing with using NBCA embolization.
Methods
cases with DAVF were selected from department of neurosurgery, southern medical university zhujiang hospital in the near10years, for which NBCA or Onyx embolization was performed, including male42cases, female37cases, and a total of79cases, age range from13to64years old, and a mean of34.3+15.7years old. The hospitalization record, endovascular treatment records, and angiography imaging were retrospectively analyzed to find the differences in treatment approach and curative effect between Onyx and NBCA embolization.
Results
Immediate angiography showed that the total occlusion rate in NBCA and Onyx group was23.8%and75.7%, near-total occlusion rate was21.4%and24.3%occlusion, uncompleted occlusion rate is54.8%and0%, P=.000, respectively; Clinical and radiographic follow-up were performed in3-36months (mean11.1±7.8months), clinical follow-up in NBCA group and Onyx group showed that the cure rate was36.6%and76.9%, improvement rate was17.1%and7.7%, invalid or recurrence rate was46.3%and15.4%, respectively, P=.005; Angiography follow-up showed that the total occlusion rate in NBCA and Onyx group was30.0%and70.0%, near-total occlusion rate was16.7%and10.0%, uncompleted occlusion rate is53.3%and20.0%, respectively, P=.019; Respectively, complication rate in the two groups was9.5%and40.5%, P=.005; Transvenous approach in the two groups was9.5%and40.5%, transarterial way was85.7%and59.5%, transvenous+transarterial way was4.8%and0%, P=003; in addition, transvenous approach was successfully applied in all csDAVF by using Onyx embolization (including via inferior petrosal sinus13/15cases, superior ophthalmic vein2/15cases), while transarterial way was performed in all ncsDAVF (including via the meningeal artery in9/22cases, pillow artery2/22cases, ear hind artery8/22cases, and multi-artery3/22cases).
Conclusion
For treating DAVF, curative effect of Onyx is better than that of NBCA, but need to pay attention to prevent and control the complications. When using Onyx, for csDAVF, transvenous way is the main embolization approach and the trans-inferior petrosal sinus is being used mostly, but for ncsDAVF, transarterial approach is the main treatment approach, and the trans-meninges artery and the posterior auricular artery are used mostly.
引文
1 Festa JR., Lazar RM, Marshall RS, et al. Dural arteriovenous fistula presents like an ischemic stroke. Cogn Behav Neurol,2004,17:50-3.
2 van Dijk JM, TerBrugge KG, Van der Meer FJ, et al. Thrombophilic factors and the formation of dural arteriovenous fistulas. J Neurosurg,2007,107:56-9.
3 Satomi J, Satoh K. [Epidemiology and etiology of dural arteriovenous fistula]. Brain Nerve,2008,60:883-6.
4 Morales H, Jones BV, Leach JL, et al. Documented development of a dural arteriovenous fistula in an infant subsequent to sinus thrombosis:case report and review of the literature. Neuroradiology,2010,52:225-9.
5 Hanaoka M, Matsubara S, Satoh K, et al. Dural arteriovenous fistulae after cerebral infarction:report of two cases. Neurosurgery,2011,68:E575-9; discussion E580.
6 Toledo MM, Wilson TJ, Dashti S, et al. Dural arteriovenous fistula associated with superior sagittal sinus occlusion secondary to invasion by a parafalcine meningioma:case report. Neurosurgery,2010,67:205-7; discussion 207.
7 Lai CW, Agid R, van den Berg R, et al. Cerebral arteriovenous fistulas induced by dural arteriovenous shunts. AJNR Am J Neuroradiol,2005,26:1259-62.
8 Cognard C, Januel AC, Silva NA Jr, et al. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage:new management using Onyx. AJNR Am J Neuroradiol,2008,29:235-41.
9 Chen L, Mao Y, Zhou LF. Local chronic hypoperfusion secondary to sinus high pressure seems to be mainly responsible for the formation of intracranial dural arteriovenous fistula. Neurosurgery,2009,64:973-83; discussion 983.
10 van Rooij WJ, Sluzewski M, Beute GN. Dural arteriovenous fistulas with cortical venous drainage:incidence, clinical presentation, and treatment. AJNR Am J Neuroradiol,2007,28:651-5.
11 Soderman M, Pavic L, Edner G, et al. Natural history of dural arteriovenous shunts. Stroke,2008,39:1735-9.
12 Turner RD, Gonugunta V, Kelly ME, et al. Marginal sinus arteriovenous fistulas mimicking carotid cavernous fistulas:diagnostic and therapeutic considerations. AJNR Am J Neuroradiol,2007,28:1915-8.
13 Safavi-Abbasi S, Di Rocco F, Nakaji P, et al. Thrombophilia Due to Factor V and Factor Ⅱ Mutations and Formation of a Dural Arteriovenous Fistula:Case Report and Review of a Rare Entity. Skull Base,2008,18:135-43.
14 Layton KF. Embolization of an intracranial dural arteriovenous fistula using ultrasound-guided puncture of a pericranial venous pouch. Proc (Bayl Univ Med Cent),2009,22:332-4.
15 Hamada Y, Goto K, Inoue T, et al. Histopathological aspects of dural arteriovenous fistulas in the transverse-sigmoid sinus region in nine patients. Neurosurgery,1997,40:452-6; discussion 456-8.
16 Geibprasert S, Pereira V, Krings T, et al. Dural arteriovenous shunts:a new classification of craniospinal epidural venous anatomical bases and clinical correlations. Stroke,2008,39:2783-94.
17 Shin Y, Uranishi R, Nakase H, ct al. [Vascular endothelial growth factor expression in the rat dural arteriovenous fistula model]. No To Shinkei, 2003,55:946-52.
18 Uranishi R, Nakase H, Sakaki T. Expression of angiogenic growth factors in dural arteriovenous fistula. J Neurosurg,1999,91:781-6.
19 Zhu Y, Lawton MT, Du R, et al. Expression of hypoxia-inducible factor-1 and vascular endothelial growth factor in response to venous hypertension. Neurosurgery,2006,59:687-96; discussion 687-96.
20 Tsai LK, Jeng JS, Liu HM, et al. Intracranial dural arteriovenous fistulas with or without cerebral sinus thrombosis:analysis of 69 patients. J Neurol Neurosurg Psychiatry,2004,75:1639-41.
21 Houser OW, Campbell JK, Campbell RJ, et al. Arteriovenous malformation affecting the transverse dural venous sinus--an acquired lesion. Mayo Clin Proc, 1979,54:651-61.
22 Gerlach R, Boehm-Weigert M, Berkefeld J, et al. THROMBOPHILIC RISKS FACTORS IN PATIENTS WITH CRANIAL AND SPINAL DURAL ARTERIOVENOUS FISTULAE. Neurosurgery,2008.
23 Kim DJ, terBrugge K, Krings T, et al. Spontaneous angiographic conversion of intracranial dural arteriovenous shunt:long-term follow-up in nontreated patients. Stroke,2010,41:1489-94.
24 Hurst RW, Bagley LJ, Galetta S, et al. Dementia resulting from dural arteriovenous fistulas:the pathologic findings of venous hypertensive encephalopathy. AJNR Am J Neuroradiol,1998,19:1267-73.
25 Strom RG, Botros JA, Refai D, et al. Cranial dural arteriovenous fistulae: asymptomatic cortical venous drainage portends less aggressive clinical course. Neurosurgery,2009,64:241-7; discussion 247-8.
26 Lucas Cde P, Caldas JG, Prandini MN. Do leptomeningeal venous drainage and dysplastic venous dilation predict hemorrhage in dural arteriovenous fistula?. Surg Neurol,2006,66 Suppl 3:S2-5; discussion S5-6.
27 Delgado F, Munoz F, Bravo-Rodriguez F, et al. Treatment of dural arteriovenous fistulas presenting as pulsatile tinnitus. Otol Neurotol,2009,30:897-902.
28 Cifarelli CP, Kaptain G, Yen CP, et al. Gamma knife radiosurgery for dural arteriovenous fistulas. Neurosurgery,2010,67:1230-5; discussion 1235.
29 Wachter D, Hans F, Psychogios MN, et al. Microsurgery can cure most intracranial dural arteriovenous fistulae of the sinus and non-sinus type. Neurosurg Rev,2011,34:337-45; discussion 345.
30 Kirsch M, Liebig T, Kuhne D, et al. Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients. Neuroradiology,2009,51:477-83.
31 Kakarla UK, Deshmukh VR, Zabramski JM, et al. Surgical treatment of high-risk intracranial dural arteriovenous fistulae:clinical outcomes and avoidance of complications. Neurosurgery,2007,61:447-57; discussion 457-9.
32 Li ZR, Jiang ZB, Huang MS, et al. Transvenous embolization of cavernous sinus dural arteriovenous fistulas using detachable coils and Glubran 2 acrylic glue via the inferior petrosal sinus approach. Eur Radiol,2010,20:2939-47.
33 Kirsch M, Henkes H, Liebig T, et al. Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients. Neuroradiology, 2006,48:486-90.
34 Panagiotopoulos V, Gizewski E, Asgari S, et al. Embolization of intracranial arteriovenous malformations with ethylene-vinyl alcohol copolymer (Onyx). AJNR Am J Neuroradiol,2009,30:99-106.
35 Theaudin M, Saint-Maurice JP, Chapot R, et al. Diagnosis and treatment of dural carotid-cavernous fistulas:a consecutive series of 27 patients. J Neurol Neurosurg Psychiatry,2007,78:174-9.
36 van Dijk JM, TerBrugge KG, Willinsky RA, et al. Selective disconnection of cortical venous reflux as treatment for cranial dural arteriovenous fistulas. J Neurosurg,2004,101:31-5.
37 Kiyosue H, Hori Y, Okahara M, et al. Treatment of intracranial dural arteriovenous fistulas:current strategies based on location and hemodynamics, and alternative techniques of transcatheter embolization. Radiographics, 2004,24:1637-53.
38 Terada T, Higashida RT, Halbach VV, et al. Development of acquired arteriovenous fistulas in rats due to venous hypertension. J Neurosurg, 1994,80:884-9.
39 Wanke I, Doerfler A, Stolke D, et al. Carotid cavernous fistula due to a ruptured intracavemous aneurysm of the internal carotid artery:treatment with selective endovascular occlusion of the aneurysm. J Neurol Neurosurg Psychiatry, 2001,71:784-7.
40 Graeb DA, Dolman CL. Radiological and pathological aspects of dural arteriovenous fistulas. Case report. J Neurosurg,1986,64:962-7.
41 Geibprasert S, Pongpech S, Armstrong D, et al. Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves:vessels the neurointerventionalist needs to know. AJNR Am J Neuroradiol, 2009,30:1459-68.
42 Mironov A. Pathogenetical consideration of spontaneous dural arteriovenous fistulas (DAVFs). Acta Neurochir (Wien),1994,131:45-58.
43 Sundt TM Jr, Piepgras DG. The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg, 1983,59:32-9.
44 Troffkin NA, Graham CB 3rd, Berkmen T, et al. Combined transvenous and transarterial embolization of a tentorial-incisural dural arteriovenous malformation followed by primary stent placement in the associated stenotic straight sinus. Case report. J Neurosurg,2003,99:579-83.
45 Yokota M, Tani E, Maeda Y, et al. Meningioma in sigmoid sinus groove associated with dural arteriovenous malformation:case report. Neurosurgery, 1993,33:316-9; discussion 319.
46 Pumar JM, Garcia-Dorrego R, Pardo MI, et al. Dural arteriovenous fistula post sinus thrombosis in puerperium. Int J Emerg Med,2010,3:513-4.
47 van Beijnum J, Klijn CJ, Lo TH, et al. Spontaneous obliteration of a dural arteriovenous fistula after treatment of polycythemia in a patient with factor V Leiden mutation:case report. J Neurol,2010,257:1573-5.
48 Herman JM, Spetzler RF, Bederson JB, et al. Genesis of a dural arteriovenous malformation in a rat model. J Neurosurg,1995,83:539-45.
49 Singh V, Smith WS, Lawton MT, et al. Risk factors for hemorrhagic presentation in patients with dural arteriovenous fistulae. Neurosurgery, 2008,62:628-35; discussion 628-35.
50 Lv X, Jiang C, Zhang J, et al. Complications related to percutaneous transarterial embolization of intracranial dural arteriovenous fistulas in 40 patients. AJNR Am J Neuroradiol,2009,30:462-8.
51 Nogueira RG, Dabus G, Rabinov JD, et al. Preliminary experience with onyx embolization for the treatment of intracranial dural arteriovenous fistulas. AJNR Am J Neuroradiol,2008,29:91-7.
52 Stiefel MF, Albuquerque FC, Park MS, et al. Endovascular treatment of intracranial dural arteriovenous fistulae using Onyx:a case series. Neurosurgery, 2009,65:132-9; discussion 139-40.
53 Miyamoto N, Naito I, Takatama S, et al. Clinical and angiographic characteristics of cavernous sinus dural arteriovenous fistulas manifesting as venous infarction and/or intracranial hemorrhage. Neuroradiology, 2009,51:53-60.
54 Willems PW, Willinsky RA, Segev Y, et al. Aggressive intracranial dural arteriovenous fistula presenting with cerebrospinal fluid rhinorrhea:case report. Neurosurgery,2009,65:E1208-9; discussion E1209.
55 Wolfe SQ, Cumberbatch NM, Aziz-Sultan MA, et al. Operative approach via the superior ophthalmic vein for the endovascular treatment of carotid cavernous fistulas that fail traditional endovascular access. Neurosurgery,2010,66:293-9; discussion 299.
56 Marques MC, Caldas JG, Nalli DR, et al. Follow-up of endovascular treatment of direct carotid-cavernous fistulas. Neuroradiology,2010,52:1127-33.
57 Luo CB, Teng MM, Chang FC, et al. Bilateral traumatic carotid-cavernous fistulae:Strategies for endovascular treatment. Acta Neurochir (Wien), 2007,149:675-80; discussion 680.
58 Wakhloo AK, Perlow A, Linfante I, et al. Transvenous n-butyl-cyanoacrylate infusion for complex dural carotid cavernous fistulas:technical considerations and clinical outcome. AJNR Am J Neuroradiol,2005,26:1888-97.
59 Nelson PK, Russell SM, Woo HH, et al. Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas:indications, endovascular technique, and outcome in 21 patients. J Neurosurg,2003,98:498-506.
60 Macdonald JH, Millar JS, Barker CS. Endovascular treatment of cranial dural arteriovenous fistulae:a single-centre,14-year experience and the impact of Onyx on local practise. Neuroradiology,2010,52:387-95.
61 Warren DJ, Craven I, Romanowski CA, et al. Spontaneous closure of a type 2a dural arteriovenous fistula following late recanalization of the occluded sinus. Interv Neuroradiol,2010,16:282-5.
62 Luciani A, Houdart E, Mounayer C, et al. Spontaneous closure of dural arteriovenous fistulas:report of three cases and review of the literature. AJNR Am J Neuroradiol,2001,22:992-6.
63 Saito A, Furuno Y, Nishimura S, et al. Spontaneous closure of transverse sinus dural arteriovenous fistula:case report. Neurol Med Chir (Tokyo), 2008,48:564-8.
64 Hallaert GG, De Keukeleire KM, Vanhauwaert DJ, et al. Intracranial dural arteriovenous fistula successfully treated by combined open-endovascular procedure. J Neurol Neurosurg Psychiatry,2010,81:685-9.
65 Halbach VV, Higashida RT, Hieshima GB, et al. Transvenous embolization of dural fistulas involving the cavernous sinus. AJNR Am J Neuroradiol, 1989,10:377-83.
66 Klisch J, Huppertz HJ, Spetzger U, et al. Transvenous treatment of carotid cavernous and dural arteriovenous fistulae:results for 31 patients and review of the literature. Neurosurgery,2003,53:836-56; discussion 856-7.
67 Nishino K, Ito Y, Hasegawa H, et al. Cranial nerve palsy following transvenous embolization for a cavernous sinus dural arteriovenous fistula:association with the volume and location of detachable coils. J Neurosurg,2008,109:208-14.
68 Kim DJ, Kim DI, Suh SH, et al. Results of transvenous embolization of cavernous dural arteriovenous fistula:a single-center experience with emphasis on complications and management. AJNR Am J Neuroradiol,2006,27:2078-82.
69 Bink A, Goller K, Luchtenberg M, et al. Long-term outcome after coil embolization of cavernous sinus arteriovenous fistulas. AJNR Am J Neuroradiol, 2010,31:1216-21.
70 Kubo M, Kuwayama N, Hirashima Y, et al. Dural arteriovenous fistulae developing at different locations after resolution of previous fistulae:report of three cases and review of the literature. AJNR Am J Neuroradiol, 2002,23:787-9.
71 Huang Q, Xu Y, Hong B, et al. Use of onyx in the management of tentorial dural arteriovenous fistulae. Neurosurgery,2009,65:287-92; discussion 292-3.
72 Amiridze N, Zoarski G, Darwish R, et al. Embolization of a Cavernous Sinus Dural Arteriovenous Fistula with Onyx via Direct Puncture of the Cavernous Sinus through the Superior Orbital Fissure:Asystole Resulting from the Trigeminocardiac Reflex. A Case Report. Interv Neuroradiol,2009,15:179-84.
73 Lv X, Li Y, Lv M, et al. Trigeminocardiac reflex in embolization of intracranial dural arteriovenous fistula. AJNR Am J Neuroradiol,2007,28:1769-70.
74 Suh DC, Lee JH, Kim SJ, et al. New concept in cavernous sinus dural arteriovenous fistula:correlation with presenting symptom and venous drainage patterns. Stroke,2005,36:1134-9.
75 Schmit BP, Burrows PE, Kuban K, et al. Acquired cerebral arteriovenous malformation in a child with moyamoya disease. Case report. J Neurosurg, 1996,84:677-80.
76 Killory BD, Gonzalez LF, Wait SD, et al. Simultaneous unilateral moyamoya disease and ipsilateral dural arteriovenous fistula:case report. Neurosurgery, 2008,62:E1375-6; discussion E1376.
77 Izumi T, Miyachi S, Hattori K, et al. Thrombophilic abnormalities among patients with cranial dural arteriovenous fistulas. Neurosurgery,2007,61:262-8; discussion 268-9.
78 Kobayashi N, Miyachi S, Negoro M, et al. Endovascular treatment strategy for direct carotid-cavernous fistulas resulting from rupture of intracavernous carotid aneurysms. AJNR Am J Neuroradiol,2003,24:1789-96.
79 Chuman H, Trobe JD, Petty EM, et al. Spontaneous direct carotid-cavernous fistula in Ehlers-Danlos syndrome type IV:two case reports and a review of the literature. J Neuroophthalmol,2002,22:75-81.
80 Metoki T, Mugikura S, Higano S, et al. Subcortical calcification on CT in dural arteriovenous fistula with cortical venous reflux. AJNR Am J Neuroradiol, 2006,27:1076-8.
81 Lee CW, Huang A, Wang YH, et al. Intracranial dural arteriovenous fistulas: diagnosis and evaluation with 64-detector row CT angiography. Radiology, 2010,256:219-28.
82 Sato K, Shimizu H, Fujimura M, et al. Compromise of brain tissue caused by cortical venous reflux of intracranial dural arteriovenous fistulas:assessment with diffusion-weighted magnetic resonance imaging. Stroke, 2011,42:998-1003.
83 Kai Y, Hamada J, Morioka M, et al. Postoperative hyperperfusion in a patient with a dural arteriovenous fistula with retrograde leptomeningeal venous drainage:case report. Neurosurgery,2003,53:228-32; discussion 232-3.
84 Noguchi K, Kubo M, Kuwayama N, et al. Intracranial dural arteriovenous fistulas with retrograde cortical venous drainage:assessment with cerebral blood volume by dynamic susceptibility contrast magnetic resonance imaging. AJNR Am J Neuroradiol,2006,27:1252-6.
85 Nishimura S, Hirai T, Sasao A, et al. Evaluation of dural arteriovenous fistulas with 4D contrast-enhanced MR angiography at 3T. AJNR Am J Neuroradiol, 2010,31:80-5.
86 Kai Y, Hamada J, Morioka M, et al. Treatment of cavernous sinus dural arteriovenous fistulae by external manual carotid compression. Neurosurgery, 2007,60:253-7; discussion 257-8.
87 Wachter D, Psychogios M, Knauth M, et al. IvACT after aneurysm clipping as an alternative to digital subtraction angiography--first experiences. Cen Eur Neurosurg,2010,71:121-5.
88 Im SH, Oh CW, Han DH. Surgical management of an unruprured dural arteriovenous fistula of the anterior cranial fossa:natural history for 7 years. SurgNeurol,2004,62:72-5; discussion 75.
89 Yoshida K, Melake M, Oishi H, et al. Transvenous embolization of dural carotid cavernous fistulas:a series of 44 consecutive patients. AJNR Am J Neuroradiol, 2010,31:651-5.
90 Guedin P, Gaillard S, Boulin A, et al. Therapeutic management of intracranial dural arteriovenous shunts with leptomeningeal venous drainage:report of 53 consecutive patients with emphasis on transarterial embolization with acrylic glue. J Neurosurg,2010,112:603-10.
91 Choi BJ, Lee TH, Kim CW, et al. Reconstructive treatment using a stent graft for a dural arteriovenous fistula of the transverse sinus in the case of hypoplasia of the contralateral venous sinuses:technical case report. Neurosurgery, 2009,65:E994-6; discussion E996.
92 Gutierrez A, Do HM, Marks MP. Alteration in the venous drainage of a dural arteriovenous fistula following angioplasty. AJNR Am J Neuroradiol, 2004,25:1086-8.
93 Yeh PS, Wu TC, Tzeng WS, et al. Endovascular angioplasty and stent placement in venous hypertension related to dural arteriovenous fistulas and venous sinus thrombosis. Clin Neurol Neurosurg,2010,112:167-71.
2 van Dijk JM, TerBrugge KG, Van der Meer FJ, et al. Thrombophilic factors and the formation of dural arteriovenous fistulas. J Neurosurg,2007,107:56-9.
3 Satomi J, Satoh K. [Epidemiology and etiology of dural arteriovenous fistula]. Brain Nerve,2008,60:883-6.
4 Morales H, Jones BV, Leach JL, et al. Documented development of a dural arteriovenous fistula in an infant subsequent to sinus thrombosis:case report and review of the literature. Neuroradiology,2010,52:225-9.
5 Hanaoka M, Matsubara S, Satoh K, et al. Dural arteriovenous fistulae after cerebral infarction:report of two cases. Neurosurgery,2011,68:E575-9; discussion E580.
6 Toledo MM, Wilson TJ, Dashti S, et al. Dural arteriovenous fistula associated with superior sagittal sinus occlusion secondary to invasion by a parafalcine meningioma:case report. Neurosurgery,2010,67:205-7; discussion 207.
7 Lai CW, Agid R, van den Berg R, et al. Cerebral arteriovenous fistulas induced by dural arteriovenous shunts. AJNR Am J Neuroradiol,2005,26:1259-62.
8 Cognard C, Januel AC, Silva NA Jr, et al. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage:new management using Onyx. AJNR Am J Neuroradiol,2008,29:235-41.
9 Chen L, Mao Y, Zhou LF. Local chronic hypoperfusion secondary to sinus high pressure seems to be mainly responsible for the formation of intracranial dural arteriovenous fistula. Neurosurgery,2009,64:973-83; discussion 983.
10 van Rooij WJ, Sluzewski M, Beute GN. Dural arteriovenous fistulas with cortical venous drainage:incidence, clinical presentation, and treatment. AJNR Am J Neuroradiol,2007,28:651-5.
11 Soderman M, Pavic L, Edner G, et al. Natural history of dural arteriovenous shunts. Stroke,2008,39:1735-9.
12 Turner RD, Gonugunta V, Kelly ME, et al. Marginal sinus arteriovenous fistulas mimicking carotid cavernous fistulas:diagnostic and therapeutic considerations. AJNR Am J Neuroradiol,2007,28:1915-8.
13 Safavi-Abbasi S, Di Rocco F, Nakaji P, et al. Thrombophilia Due to Factor V and Factor Ⅱ Mutations and Formation of a Dural Arteriovenous Fistula:Case Report and Review of a Rare Entity. Skull Base,2008,18:135-43.
14 Layton KF. Embolization of an intracranial dural arteriovenous fistula using ultrasound-guided puncture of a pericranial venous pouch. Proc (Bayl Univ Med Cent),2009,22:332-4.
15 Hamada Y, Goto K, Inoue T, et al. Histopathological aspects of dural arteriovenous fistulas in the transverse-sigmoid sinus region in nine patients. Neurosurgery,1997,40:452-6; discussion 456-8.
16 Geibprasert S, Pereira V, Krings T, et al. Dural arteriovenous shunts:a new classification of craniospinal epidural venous anatomical bases and clinical correlations. Stroke,2008,39:2783-94.
17 Shin Y, Uranishi R, Nakase H, ct al. [Vascular endothelial growth factor expression in the rat dural arteriovenous fistula model]. No To Shinkei, 2003,55:946-52.
18 Uranishi R, Nakase H, Sakaki T. Expression of angiogenic growth factors in dural arteriovenous fistula. J Neurosurg,1999,91:781-6.
19 Zhu Y, Lawton MT, Du R, et al. Expression of hypoxia-inducible factor-1 and vascular endothelial growth factor in response to venous hypertension. Neurosurgery,2006,59:687-96; discussion 687-96.
20 Tsai LK, Jeng JS, Liu HM, et al. Intracranial dural arteriovenous fistulas with or without cerebral sinus thrombosis:analysis of 69 patients. J Neurol Neurosurg Psychiatry,2004,75:1639-41.
21 Houser OW, Campbell JK, Campbell RJ, et al. Arteriovenous malformation affecting the transverse dural venous sinus--an acquired lesion. Mayo Clin Proc, 1979,54:651-61.
22 Gerlach R, Boehm-Weigert M, Berkefeld J, et al. THROMBOPHILIC RISKS FACTORS IN PATIENTS WITH CRANIAL AND SPINAL DURAL ARTERIOVENOUS FISTULAE. Neurosurgery,2008.
23 Kim DJ, terBrugge K, Krings T, et al. Spontaneous angiographic conversion of intracranial dural arteriovenous shunt:long-term follow-up in nontreated patients. Stroke,2010,41:1489-94.
24 Hurst RW, Bagley LJ, Galetta S, et al. Dementia resulting from dural arteriovenous fistulas:the pathologic findings of venous hypertensive encephalopathy. AJNR Am J Neuroradiol,1998,19:1267-73.
25 Strom RG, Botros JA, Refai D, et al. Cranial dural arteriovenous fistulae: asymptomatic cortical venous drainage portends less aggressive clinical course. Neurosurgery,2009,64:241-7; discussion 247-8.
26 Lucas Cde P, Caldas JG, Prandini MN. Do leptomeningeal venous drainage and dysplastic venous dilation predict hemorrhage in dural arteriovenous fistula?. Surg Neurol,2006,66 Suppl 3:S2-5; discussion S5-6.
27 Delgado F, Munoz F, Bravo-Rodriguez F, et al. Treatment of dural arteriovenous fistulas presenting as pulsatile tinnitus. Otol Neurotol,2009,30:897-902.
28 Cifarelli CP, Kaptain G, Yen CP, et al. Gamma knife radiosurgery for dural arteriovenous fistulas. Neurosurgery,2010,67:1230-5; discussion 1235.
29 Wachter D, Hans F, Psychogios MN, et al. Microsurgery can cure most intracranial dural arteriovenous fistulae of the sinus and non-sinus type. Neurosurg Rev,2011,34:337-45; discussion 345.
30 Kirsch M, Liebig T, Kuhne D, et al. Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients. Neuroradiology,2009,51:477-83.
31 Kakarla UK, Deshmukh VR, Zabramski JM, et al. Surgical treatment of high-risk intracranial dural arteriovenous fistulae:clinical outcomes and avoidance of complications. Neurosurgery,2007,61:447-57; discussion 457-9.
32 Li ZR, Jiang ZB, Huang MS, et al. Transvenous embolization of cavernous sinus dural arteriovenous fistulas using detachable coils and Glubran 2 acrylic glue via the inferior petrosal sinus approach. Eur Radiol,2010,20:2939-47.
33 Kirsch M, Henkes H, Liebig T, et al. Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients. Neuroradiology, 2006,48:486-90.
34 Panagiotopoulos V, Gizewski E, Asgari S, et al. Embolization of intracranial arteriovenous malformations with ethylene-vinyl alcohol copolymer (Onyx). AJNR Am J Neuroradiol,2009,30:99-106.
35 Theaudin M, Saint-Maurice JP, Chapot R, et al. Diagnosis and treatment of dural carotid-cavernous fistulas:a consecutive series of 27 patients. J Neurol Neurosurg Psychiatry,2007,78:174-9.
36 van Dijk JM, TerBrugge KG, Willinsky RA, et al. Selective disconnection of cortical venous reflux as treatment for cranial dural arteriovenous fistulas. J Neurosurg,2004,101:31-5.
37 Kiyosue H, Hori Y, Okahara M, et al. Treatment of intracranial dural arteriovenous fistulas:current strategies based on location and hemodynamics, and alternative techniques of transcatheter embolization. Radiographics, 2004,24:1637-53.
38 Terada T, Higashida RT, Halbach VV, et al. Development of acquired arteriovenous fistulas in rats due to venous hypertension. J Neurosurg, 1994,80:884-9.
39 Wanke I, Doerfler A, Stolke D, et al. Carotid cavernous fistula due to a ruptured intracavemous aneurysm of the internal carotid artery:treatment with selective endovascular occlusion of the aneurysm. J Neurol Neurosurg Psychiatry, 2001,71:784-7.
40 Graeb DA, Dolman CL. Radiological and pathological aspects of dural arteriovenous fistulas. Case report. J Neurosurg,1986,64:962-7.
41 Geibprasert S, Pongpech S, Armstrong D, et al. Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves:vessels the neurointerventionalist needs to know. AJNR Am J Neuroradiol, 2009,30:1459-68.
42 Mironov A. Pathogenetical consideration of spontaneous dural arteriovenous fistulas (DAVFs). Acta Neurochir (Wien),1994,131:45-58.
43 Sundt TM Jr, Piepgras DG. The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg, 1983,59:32-9.
44 Troffkin NA, Graham CB 3rd, Berkmen T, et al. Combined transvenous and transarterial embolization of a tentorial-incisural dural arteriovenous malformation followed by primary stent placement in the associated stenotic straight sinus. Case report. J Neurosurg,2003,99:579-83.
45 Yokota M, Tani E, Maeda Y, et al. Meningioma in sigmoid sinus groove associated with dural arteriovenous malformation:case report. Neurosurgery, 1993,33:316-9; discussion 319.
46 Pumar JM, Garcia-Dorrego R, Pardo MI, et al. Dural arteriovenous fistula post sinus thrombosis in puerperium. Int J Emerg Med,2010,3:513-4.
47 van Beijnum J, Klijn CJ, Lo TH, et al. Spontaneous obliteration of a dural arteriovenous fistula after treatment of polycythemia in a patient with factor V Leiden mutation:case report. J Neurol,2010,257:1573-5.
48 Herman JM, Spetzler RF, Bederson JB, et al. Genesis of a dural arteriovenous malformation in a rat model. J Neurosurg,1995,83:539-45.
49 Singh V, Smith WS, Lawton MT, et al. Risk factors for hemorrhagic presentation in patients with dural arteriovenous fistulae. Neurosurgery, 2008,62:628-35; discussion 628-35.
50 Lv X, Jiang C, Zhang J, et al. Complications related to percutaneous transarterial embolization of intracranial dural arteriovenous fistulas in 40 patients. AJNR Am J Neuroradiol,2009,30:462-8.
51 Nogueira RG, Dabus G, Rabinov JD, et al. Preliminary experience with onyx embolization for the treatment of intracranial dural arteriovenous fistulas. AJNR Am J Neuroradiol,2008,29:91-7.
52 Stiefel MF, Albuquerque FC, Park MS, et al. Endovascular treatment of intracranial dural arteriovenous fistulae using Onyx:a case series. Neurosurgery, 2009,65:132-9; discussion 139-40.
53 Miyamoto N, Naito I, Takatama S, et al. Clinical and angiographic characteristics of cavernous sinus dural arteriovenous fistulas manifesting as venous infarction and/or intracranial hemorrhage. Neuroradiology, 2009,51:53-60.
54 Willems PW, Willinsky RA, Segev Y, et al. Aggressive intracranial dural arteriovenous fistula presenting with cerebrospinal fluid rhinorrhea:case report. Neurosurgery,2009,65:E1208-9; discussion E1209.
55 Wolfe SQ, Cumberbatch NM, Aziz-Sultan MA, et al. Operative approach via the superior ophthalmic vein for the endovascular treatment of carotid cavernous fistulas that fail traditional endovascular access. Neurosurgery,2010,66:293-9; discussion 299.
56 Marques MC, Caldas JG, Nalli DR, et al. Follow-up of endovascular treatment of direct carotid-cavernous fistulas. Neuroradiology,2010,52:1127-33.
57 Luo CB, Teng MM, Chang FC, et al. Bilateral traumatic carotid-cavernous fistulae:Strategies for endovascular treatment. Acta Neurochir (Wien), 2007,149:675-80; discussion 680.
58 Wakhloo AK, Perlow A, Linfante I, et al. Transvenous n-butyl-cyanoacrylate infusion for complex dural carotid cavernous fistulas:technical considerations and clinical outcome. AJNR Am J Neuroradiol,2005,26:1888-97.
59 Nelson PK, Russell SM, Woo HH, et al. Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas:indications, endovascular technique, and outcome in 21 patients. J Neurosurg,2003,98:498-506.
60 Macdonald JH, Millar JS, Barker CS. Endovascular treatment of cranial dural arteriovenous fistulae:a single-centre,14-year experience and the impact of Onyx on local practise. Neuroradiology,2010,52:387-95.
61 Warren DJ, Craven I, Romanowski CA, et al. Spontaneous closure of a type 2a dural arteriovenous fistula following late recanalization of the occluded sinus. Interv Neuroradiol,2010,16:282-5.
62 Luciani A, Houdart E, Mounayer C, et al. Spontaneous closure of dural arteriovenous fistulas:report of three cases and review of the literature. AJNR Am J Neuroradiol,2001,22:992-6.
63 Saito A, Furuno Y, Nishimura S, et al. Spontaneous closure of transverse sinus dural arteriovenous fistula:case report. Neurol Med Chir (Tokyo), 2008,48:564-8.
64 Hallaert GG, De Keukeleire KM, Vanhauwaert DJ, et al. Intracranial dural arteriovenous fistula successfully treated by combined open-endovascular procedure. J Neurol Neurosurg Psychiatry,2010,81:685-9.
65 Halbach VV, Higashida RT, Hieshima GB, et al. Transvenous embolization of dural fistulas involving the cavernous sinus. AJNR Am J Neuroradiol, 1989,10:377-83.
66 Klisch J, Huppertz HJ, Spetzger U, et al. Transvenous treatment of carotid cavernous and dural arteriovenous fistulae:results for 31 patients and review of the literature. Neurosurgery,2003,53:836-56; discussion 856-7.
67 Nishino K, Ito Y, Hasegawa H, et al. Cranial nerve palsy following transvenous embolization for a cavernous sinus dural arteriovenous fistula:association with the volume and location of detachable coils. J Neurosurg,2008,109:208-14.
68 Kim DJ, Kim DI, Suh SH, et al. Results of transvenous embolization of cavernous dural arteriovenous fistula:a single-center experience with emphasis on complications and management. AJNR Am J Neuroradiol,2006,27:2078-82.
69 Bink A, Goller K, Luchtenberg M, et al. Long-term outcome after coil embolization of cavernous sinus arteriovenous fistulas. AJNR Am J Neuroradiol, 2010,31:1216-21.
70 Kubo M, Kuwayama N, Hirashima Y, et al. Dural arteriovenous fistulae developing at different locations after resolution of previous fistulae:report of three cases and review of the literature. AJNR Am J Neuroradiol, 2002,23:787-9.
71 Huang Q, Xu Y, Hong B, et al. Use of onyx in the management of tentorial dural arteriovenous fistulae. Neurosurgery,2009,65:287-92; discussion 292-3.
72 Amiridze N, Zoarski G, Darwish R, et al. Embolization of a Cavernous Sinus Dural Arteriovenous Fistula with Onyx via Direct Puncture of the Cavernous Sinus through the Superior Orbital Fissure:Asystole Resulting from the Trigeminocardiac Reflex. A Case Report. Interv Neuroradiol,2009,15:179-84.
73 Lv X, Li Y, Lv M, et al. Trigeminocardiac reflex in embolization of intracranial dural arteriovenous fistula. AJNR Am J Neuroradiol,2007,28:1769-70.
74 Suh DC, Lee JH, Kim SJ, et al. New concept in cavernous sinus dural arteriovenous fistula:correlation with presenting symptom and venous drainage patterns. Stroke,2005,36:1134-9.
75 Schmit BP, Burrows PE, Kuban K, et al. Acquired cerebral arteriovenous malformation in a child with moyamoya disease. Case report. J Neurosurg, 1996,84:677-80.
76 Killory BD, Gonzalez LF, Wait SD, et al. Simultaneous unilateral moyamoya disease and ipsilateral dural arteriovenous fistula:case report. Neurosurgery, 2008,62:E1375-6; discussion E1376.
77 Izumi T, Miyachi S, Hattori K, et al. Thrombophilic abnormalities among patients with cranial dural arteriovenous fistulas. Neurosurgery,2007,61:262-8; discussion 268-9.
78 Kobayashi N, Miyachi S, Negoro M, et al. Endovascular treatment strategy for direct carotid-cavernous fistulas resulting from rupture of intracavernous carotid aneurysms. AJNR Am J Neuroradiol,2003,24:1789-96.
79 Chuman H, Trobe JD, Petty EM, et al. Spontaneous direct carotid-cavernous fistula in Ehlers-Danlos syndrome type IV:two case reports and a review of the literature. J Neuroophthalmol,2002,22:75-81.
80 Metoki T, Mugikura S, Higano S, et al. Subcortical calcification on CT in dural arteriovenous fistula with cortical venous reflux. AJNR Am J Neuroradiol, 2006,27:1076-8.
81 Lee CW, Huang A, Wang YH, et al. Intracranial dural arteriovenous fistulas: diagnosis and evaluation with 64-detector row CT angiography. Radiology, 2010,256:219-28.
82 Sato K, Shimizu H, Fujimura M, et al. Compromise of brain tissue caused by cortical venous reflux of intracranial dural arteriovenous fistulas:assessment with diffusion-weighted magnetic resonance imaging. Stroke, 2011,42:998-1003.
83 Kai Y, Hamada J, Morioka M, et al. Postoperative hyperperfusion in a patient with a dural arteriovenous fistula with retrograde leptomeningeal venous drainage:case report. Neurosurgery,2003,53:228-32; discussion 232-3.
84 Noguchi K, Kubo M, Kuwayama N, et al. Intracranial dural arteriovenous fistulas with retrograde cortical venous drainage:assessment with cerebral blood volume by dynamic susceptibility contrast magnetic resonance imaging. AJNR Am J Neuroradiol,2006,27:1252-6.
85 Nishimura S, Hirai T, Sasao A, et al. Evaluation of dural arteriovenous fistulas with 4D contrast-enhanced MR angiography at 3T. AJNR Am J Neuroradiol, 2010,31:80-5.
86 Kai Y, Hamada J, Morioka M, et al. Treatment of cavernous sinus dural arteriovenous fistulae by external manual carotid compression. Neurosurgery, 2007,60:253-7; discussion 257-8.
87 Wachter D, Psychogios M, Knauth M, et al. IvACT after aneurysm clipping as an alternative to digital subtraction angiography--first experiences. Cen Eur Neurosurg,2010,71:121-5.
88 Im SH, Oh CW, Han DH. Surgical management of an unruprured dural arteriovenous fistula of the anterior cranial fossa:natural history for 7 years. SurgNeurol,2004,62:72-5; discussion 75.
89 Yoshida K, Melake M, Oishi H, et al. Transvenous embolization of dural carotid cavernous fistulas:a series of 44 consecutive patients. AJNR Am J Neuroradiol, 2010,31:651-5.
90 Guedin P, Gaillard S, Boulin A, et al. Therapeutic management of intracranial dural arteriovenous shunts with leptomeningeal venous drainage:report of 53 consecutive patients with emphasis on transarterial embolization with acrylic glue. J Neurosurg,2010,112:603-10.
91 Choi BJ, Lee TH, Kim CW, et al. Reconstructive treatment using a stent graft for a dural arteriovenous fistula of the transverse sinus in the case of hypoplasia of the contralateral venous sinuses:technical case report. Neurosurgery, 2009,65:E994-6; discussion E996.
92 Gutierrez A, Do HM, Marks MP. Alteration in the venous drainage of a dural arteriovenous fistula following angioplasty. AJNR Am J Neuroradiol, 2004,25:1086-8.
93 Yeh PS, Wu TC, Tzeng WS, et al. Endovascular angioplasty and stent placement in venous hypertension related to dural arteriovenous fistulas and venous sinus thrombosis. Clin Neurol Neurosurg,2010,112:167-71.