Management strategies for anterior cranial fossa (ethmoidal) dural arteriovenous fistulas with an emphasis on endovascular treatment

Clinical article

Ronit Agid M.D.1, Karel TerBrugge M.D.1, Georges Rodesch M.D., Ph.D.2, Tommy Andersson M.D., Ph.D.3, and Michael Söderman M.D., Ph.D.3
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  • 1 Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Ontario, Canada;
  • | 2 Service de Neuroradiologie Vasculaire Diagnostique et Thérapeutique, Hôpital Foch, Suresnes, France and
  • | 3 Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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Object

Dural arteriovenous fistulas (DAVFs) of the anterior cranial fossa are rare lesions that can cause intracranial hemorrhage. Authors of previous reports mostly have described open surgical treatment for this fistula type. The authors' purpose in the present study was to describe their experience with anterior cranial fossa DAVFs, including their endovascular treatment.

Methods

All patients with anterior cranial fossa DAVFs diagnosed and treated in 3 separate institutions during the last 23 years were retrospectively identified. Clinical charts, imaging studies, and procedural notes were evaluated.

Results

Twenty-four patients (22 males and 2 females), ranging in age from 3 to 77 years, harbored 24 DAVFs in the anterior cranial fossa. Eleven patients were primarily treated with surgical disconnection and 2 with radiosurgery. Eleven patients were treated endovascularly; 7 of these patients (63.6%) were cured. In 4 cases of failed embolization, final disconnection was achieved through surgery. In fact, surgery was effective in disconnecting the fistula in 100% of cases. All endovascular procedures consisted of transarterial injections of diluted glue (N-butyl cyanoacrylate [NBCA]), and there were no complications. Brain edema developed around the venous pouch and confusion was apparent after venous disconnection in 1 surgically treated patient. No patient suffered a hemorrhage during the follow-up period.

Conclusions

Disconnection of an anterior cranial fossa DAVF by using transarterial catheterization through the ophthalmic artery and subsequent injection of NBCA is possible with a reasonable success rate and low risk for complications. In patients with good vascular access this procedure could be the treatment of choice, to be followed by open surgery in cases of embolization failure.

Abbreviations used in this paper:

AVM = arteriovenous malformation; DAVF = dural arteriovenous fistula; DS = digital subtraction; ECA = external carotid artery; ICA = internal carotid artery; ICH = intracerebral hematoma; NBCA = N-butyl cyanoacrylate; OphA = ophthalmic artery; PVA = polyvinyl alcohol; SSS = superior sagittal sinus.

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  • 1

    Abrahams JM, , Bagley LJ, , Flamm ES, , Hurst RW, & Sinson GP: Alternative management considerations for ethmoidal dural arteriovenous fistulas. Surg Neurol 58:410416, 2002

    • Search Google Scholar
    • Export Citation
  • 2

    Andersson L, , Kihlström L, & Söderman M: Regression of a flow-related ophthalmic artery aneurysm after treatment of a frontal DAVS. A case report Interventional Neuroradiology 10:265268, 2004

    • Search Google Scholar
    • Export Citation
  • 3

    Borden JA, , Wu JK, & Shucart WA: A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82:166179, 1995

    • Search Google Scholar
    • Export Citation
  • 4

    Davies MA, , TerBrugge K, , Willinsky R, , Coyne T, , Saleh J, & Wallace MC: The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 85:830837, 1996

    • Search Google Scholar
    • Export Citation
  • 5

    Defreyne L, , Vanlangenhove P, , Vandekerckhove T, , Deschrijver I, , Sieben G, & Klaes R, et al.: Transvenous embolization of a dural arteriovenous fistula of the anterior cranial fossa: preliminary results. AJNR Am J Neuroradiol 21:761765, 2000

    • Search Google Scholar
    • Export Citation
  • 6

    Dietrich U, , Wanke I, , Asgari S, , Forsting M, & Oppel F: Dural arteriovenous fistulas with intracranial hemorrhage: diagnostic and therapeutic aspects. Zentralbl Neurochir 64:1218, 2003

    • Search Google Scholar
    • Export Citation
  • 7

    Halbach VV, , Higashida RT, , Hieshima GB, , Wilson CB, , Barnwell SL, & Dowd CF: Dural arteriovenous fistulas supplied by ethmoidal arteries. Neurosurgery 26:816823, 1990

    • Search Google Scholar
    • Export Citation
  • 8

    Im SH, , Oh CW, & Han DH: Surgical management of an unruptured dural arteriovenous fistula of the anterior cranial fossa: natural history for 7 years. Surg Neurol 62:7275, 2004

    • Search Google Scholar
    • Export Citation
  • 9

    Jamous MA, , Satoh K, , Satomi J, , Matsubara S, , Nakajima N, & Uno M, et al.: Detection of enlarged cortical vein by magnetic resonance imaging contributes to early diagnosis and better outcome for patients with anterior cranial fossa dural arteriovenous fistula. Neurol Med Chir (Tokyo) 44:516521, 2004

    • Search Google Scholar
    • Export Citation
  • 10

    Kakarla UK, , Deshmukh VR, , Zabramski JM, , Albuquerque FC, , McDougall CG, & Spetzler RF: Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications. Neurosurgery 61:447449, 2007

    • Search Google Scholar
    • Export Citation
  • 11

    Lasjaunias P, , Geibprasert S, , Krings T, , Pereira V, , Jiarakongmun P, & Aurboonyawat T, et al.: Dural arteriovenous shunts: a new classification. Part 1: craniospinal epidural venous anatomical bases. Stroke [in press] 2008

    • Search Google Scholar
    • Export Citation
  • 12

    Matsumaru Y, , Alvarez H, , Rodesch G, & Lasjaunias P: Embolisation of branches of the ophthalmic artery. Interventional Neuroradiology 3:239245, 1997

    • Search Google Scholar
    • Export Citation
  • 13

    Mayfrank L, , Reul J, , Huffmann B, , Bertalanffy H, , Spetzger U, & Gilsbach JM: Microsurgical interhemispheric approach to dural arteriovenous fistulas of the floor of the anterior cranial fossa. Minim Invasive Neurosurg 39:7477, 1996

    • Search Google Scholar
    • Export Citation
  • 14

    Nelson PK, , Russell SM, , Woo HH, , Alastra AJ, & Vidovich DV: 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 98:498506, 2003

    • Search Google Scholar
    • Export Citation
  • 15

    Ogawa T, , Okudera T, , Miyauchi T, , Inugami A, , Uemura K, & Yasui N: Anterior cranial fossa dural arteriovenous fistula with a varix mimicking an anterior communicating artery aneurysm. Neuroradiology 38:252253, 1996

    • Search Google Scholar
    • Export Citation
  • 16

    Pelz DM, , Lownie SP, , Fox AJ, & Rosso D: Intracranial dural arteriovenous fistulae with pial venous drainage: combined endovascular-neurosurgical therapy. Can J Neurol Sci 24:210 218, 1997

    • Search Google Scholar
    • Export Citation
  • 17

    Reul J, , Thron A, , Laborde G, & Bruckmann H: Dural arteriovenous malformations at the base of the anterior cranial fossa: report of nine cases. Neuroradiology 35:388393, 1993

    • Search Google Scholar
    • Export Citation
  • 18

    Söderman M, , Edner G, , Ericson K, , Karlsson B, , Rahn T, & Ulfarsson E, et al.: Gamma knife surgery for dural arteriovenous shunts: 25 years of experience. J Neurosurg 104:867875, 2006

    • Search Google Scholar
    • Export Citation
  • 19

    Söderman M, , Pavic L, , Edner G, , Holmin S, & Andersson T: Natural history of dural arteriovenous shunts. Stroke 39:17351739, 2008

  • 20

    van Dijk JM, , terBrugge KG, , Willinsky RA, & Wallace MC: Clinical course of cranial dural arteriovenous fistulas with longterm persistent cortical venous reflux. Stroke 33:12331236, 2002

    • Search Google Scholar
    • Export Citation
  • 21

    van Dijk JM, , terBrugge KG, , Willinsky RA, & Wallace MC: Selective disconnection of cortical venous reflux as treatment for cranial dural arteriovenous fistulas. J Neurosurg 101:3135, 2004

    • Search Google Scholar
    • Export Citation
  • 22

    Xavier J, , Cruz R, , Stocker A, , Vasconcelos C, , Reis J, & Almeida-Pinto J: [Dural fistulas of the anterior cranial fossa.]. Acta Med Port 14:7175, 2001. (Portuguese)

    • Search Google Scholar
    • Export Citation
  • 23

    Yamaguchi S, , Takeuchi Y, , Nakayama K, , Arakawa M, & Shigemori M: [Two surgically treated cases with dural arteriovenous malformation in the anterior cranial fossa.]. No Shinkei Geka 33:12191226, 2005. (Jpn)

    • Search Google Scholar
    • Export Citation

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