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(A-B) -Lateral right common carotid angiogram ( Panel A ) demonstrates multiple arterial feeders to the dural sinus (green arrow) with a faint draining cortical vein (blue arrow). Arterial feeders include the occipital artery (red arrows), ascending pharyngeal artery (yellow arrow), petrosal branch (purple arrow), and petrosquamosal branch (orange arrow) of the middle meningeal artery. The right internal carotid artery (white arrow) is shown for orientation. Lateral postembolization angiogram ( Panel B ) demonstrates absence of the larger occipital arterial feeder and persistence of the remaining smaller tortuous arterial feeders (the same colored arrow labels apply). Note the mildly decreased opacification of the dural sinus and absence of the draining cortical vein.
Source publication
Dural arteriovenous fistulas are rare intracranial vascular malformations with a propensity for hemorrhage. The Cognard classification system is the most widespread classification system wherein type IIB through V must be promptly treated to avoid the risk of hemorrhage. The case presented herein reports a 71-year-old male presenting with vague non...
Contexts in source publication
Context 1
... magnified super selective angiogram of the distal left occipital artery demonstrated well-defined early opacification of the dural sinus and a draining cortical vein ( Fig. 3 B). A right common carotid angiogram demonstrated four separate arterial feeder vessels from the occipital artery, ascending pharyngeal artery, and petrosal and petrosquamosal branches of the right middle meningeal artery ( Fig. 4 A). ...
Context 2
... first stage included total embolization of the left occipital artery ( Fig. 3 C) and marked reduction of supply from the right-sided arterial feeders (image not shown). The larger of the two right occipital arterial feeders was embolized, however, the multiple smaller tortuous arterial feeders were not amenable for embolization ( Fig. 4 C). As there were no signs of high-risk features of cortical venous drainage, the decision was made to have the patient follow up in the outpatient setting with the neurointerventional service in three months for a second stage embolization. ...
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Dural arteriovenous fistulas are rare intracranial vascular malformations with a propensity for hemorrhage. The Cognard classification system is the most widespread classification system wherein type IIB through V must be promptly treated to avoid the risk of hemorrhage. The case presented herein reports a 65 -year-old male presenting with vague no...
Spinal dural arteriovenous fistulas (SDAVF) are the most common vascular malformations affecting the spinal cord. It is infrequently encountered in clinical practice and is believed to be acquired, predominantly affecting middle-aged and elderly men with unknown etiology. It is usually misdiagnosed despite presenting with conventional clinical find...
Precise evaluation of the feeders, fistulous points, and draining veins plays a key role for successful embolization of intracranial dural arteriovenous fistulas (DAVF). Digital subtraction angiography (DSA) is a gold standard diagnostic tool to assess the exact angioarchitecture of DAVFs. With the advent of new image postprocessing techniques, we...
Dural arteriovenous fistulas (DAVFs) are rare intracranial vascular malformations that present with a variety of clinical signs and symptoms. Among these, intracranial hemorrhage is a severe complication. A 72-year-old male presented with headache and pulsatile tinnitus. Cerebral angiography revealed a Borden II/Cognard IIa+b DAVF. He underwent sta...
Accounting for 70% of all spinal vascular malformations, spinal dural arteriovenous fistulas (SDAVF) are the most common type of malformation. Interruption of the fistulous arterialized vein point is the goal of surgical treatment. The aim of the study was to compare open surgery (laminectomy) versus minimal invasive surgery (MIS) in SDAVF treatmen...
Citations
... Within the brain, atypical connections between arteries and veins are referred to as dural arteriovenous fistulas (DAVFs). Intracranial DAVFs are abnormal direct shunts between the meningeal veins, cortical veins, or dural arteries, and the dural venous sinuses [1]. The most often documented sites for DAVFs in adult patients are the cavernous sinus and the transverse-sigmoid sinus region, with a left-sided predominance. ...
Vascular anomalies known as dural arteriovenous fistulas (DAVFs) occur when arteries that emerge from carotid or vertebral artery branches empty straight into the dural venous sinuses. A 16-year-old male patient at the center of this case study initially arrived at the hospital with symptoms of generalized tonic-clonic seizures and headaches accompanied by vomiting, followed by right-sided hemiparesis and subsequently left-sided hemiparesis. An MRI brain with MR angiography was performed, revealing an abnormal fistulous connection between the sigmoid and transverse sinus and the branches of the bilateral external carotid and right internal carotid artery. Embolization was performed using a mixture of glue and lipoid to address the issue.
... Dural arteriovenous fistulas (AVFs) are pathological continuations between the arteries and veins without an interposing capillary network within the dural folds [1,2]. Dural AVFs account for approximately 10-15 % of all intracranial vascular malformations [3,4]. ...
... The presenting symptoms of dural AVFs are highly variable [2]. Headache, dizziness, tinnitus, chemosis, proptosis, cognitive impairment, and behavioral changes are all reported as presenting symptoms [6,7]. ...
... Later on, she was found to have high flow dural AVFs. Dural AVF is a severe and uncommon condition in which the meningeal arteries are pathologically connected to dural venous sinuses or cortical veins [1,2]. It is still unknown how these fistulas are developed; however, it's thought to be a multifactorial condition resulting from environmental and hemodynamic factors. ...
Introduction and importance
Multiple dural arteriovenous fistulas (AVFs) are rare intracranial vascular malformations with fatal consequences. Patients usually manifest with variable clinical presentations, which depend on the fistula's size, location, and the development of complication. Digital subtraction angiography continues to be the gold standard neuroimaging modality for diagnosis.
Case presentation
A 47-year-old female patient was transferred from Gaza Hospital intubated under complete sedation after she had progressive confusion and abnormal behaviors. She was immediately admitted to our surgical ICU. Brain computed tomography angiography was done and showed middle and posterior cranial fossae high flow dural AVFs with grad IV Cognard classification. Also, right petrosal venous sinuses thrombosis, secondary brain edema and herniation were found. Cerebral catheterization revealed multiple dural AVFs with all branches of external carotid arteries and other branches from vertebral arteries fistulized into the transverse dural sinus, superior sagittal sinus, and sigmoid sinus.
Clinical discussion
Even though they are rare multiple dural AVFs do exist, and it is importance to consider while assessing patients who have symptoms that could point to arteriovenous fistulas. Early diagnosis and prompt intervention is a crucial step in such cases.
Conclusion
Multiple dural AVFs are rare conditions that are challenging, especially in low-middle-income countries where expertise and clinical resources are limited. A delay in the diagnosis may result in considerable morbidity and mortality.
Background
Dural arteriovenous fistulas (dAVFs) draining into the vein of Galen (VoG) are complex lesions that often necessitate treatment to minimize the risk of rupture and relieve symptoms. These lesions can be treated with open surgical resection, radiosurgery, or endovascular embolization. Unfortunately, endovascular treatment of dAVFs involving the VoG has not been robustly assessed across large patient cohorts. To meet this need, we performed a retrospective review of dAVFs involving the VoG at our center, and included these in a meta-analysis to identify the safety and efficacy of endovascular embolization, as well as describing current treatment trends for this disease.
Methods
Consecutive patients with dAVFs involving the VoG treated at a single center were identified from a prospective database and retrospectively reviewed. A literature search was conducted with defined search criteria, and eligible studies were included alongside our cohort in a meta-analysis. Rates of complete dAVF treatment and clinical complications were pooled across studies with a random effects model and reported with a 95% CI.
Results
Five dAVFs involving the VoG were treated endovascularly at our center during the study period. In this series, 80% of treatments led to complete occlusion of the fistula while no patients had clinical complications. Onyx was used for all treatments. In our meta-analysis, the overall rate of complete occlusion was 72.0% (95% CI 59.8% to 84.1%) and the overall rate of clinical complications was 10.0% (95% CI 4.7% to 15.3%).
Conclusions
Endovascular approaches for dAVFs involving the VoG are technically feasible, but carry a risk of clinical complications. Future work should identify optimal endovascular embolic agents.
