Therapeutic management of intracranial dural arteriovenous shunts with leptomeningeal venous drainage: report of 53 consecutive patients with emphasis on transarterial embolization with acrylic glue

Clinical article

View More View Less
  • 1 Department of Neuroradiology, Centre Hospitalier Universitaire Côte de Nacre, Caen; and
  • | 2 Departments of Neurosurgery,
  • | 3 Diagnostic and Therapeutic Neuroradiology, and
  • | 4 Neurology, Hôpital Foch, Suresnes, France
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

Object

There is a strong correlation between the venous drainage pattern of intracranial dural arteriovenous shunts (ICDAVSs) and the affected patients' clinical presentation. The ICDAVSs that have cortical venous reflux (CVR) (retrograde leptomeningeal drainage: Borden Type 2 and 3 lesions) are very aggressive and have a poor natural history. Although the necessity of treatment remains debatable in ICDAVSs that drain exclusively into a sinus (Borden Type 1), lesions with CVR must be treated because of the negative effects of the retrograde venous drainage. Surgery, radiosurgery, and embolization have been proposed for management of these lesions, but endovascular therapy is considered the most appropriate therapeutic strategy in ICDAVSs. New embolic materials, such as Onyx, have been recently developed and are considered to represent a kind of “gold standard” for embolization of these lesions. The purpose of this study is to emphasize the importance of transarterial embolization using acrylic glue in the therapeutic management of ICDAVSs with CVR, and to compare the results the authors obtained using this treatment with those reported in the literature for Onyx treatment of the same type of dural shunts.

Methods

The clinical and radiological records of 53 consecutive patients suffering from ICDAVSs with CVR (Borden Types 2 or 3) were reviewed. All cases were managed with the same angiographic and therapeutic protocol. Localization of the lesions, their clinical symptoms, their angioarchitecture, their therapeutic management, and the results were analyzed.

Results

Fourteen ICDAVSs were located at the superior sagittal sinus and/or convexity veins, 13 at the transverse and sigmoid sinuses, 10 at the tentorium, 5 in the anterior cranial fossa, 4 at the foramen magnum, 3 at the torcula, 2 at the straight sinus, and 1 at the vein of Galen. One patient presented with an infantile form of ICDAVS with multiple shunts. Hemorrhage had occurred in 36% of cases. Forty-three patients underwent transarterial embolization (42 with acrylic glue). Complete closure of the fistula was obtained in 34 patients. Suppression of the CVR with partial occlusion of the main shunt was achieved in all other cases. No mortality or permanent morbidity was observed in this series.

Conclusions

Intracranial dural arteriovenous shunts can be safely managed by transarterial embolization, which can be considered in most instances as an effective first-intention treatment. Acrylic glue still allows a cheap, fast, and effective treatment with high rates of cures that compare favorably to those obtained with new embolic materials.

Abbreviations used in this paper:

CVR = cortical venous reflux; ICDAVS = intracranial dural arteriovenous shunt; NBCA = N-butylcyanoacrylate; VA = vertebral artery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    Berenstein A, , Lasjaunias P, & Terbrugge KG: Dural arteriovenous shunts. Surgical Neuroangiography ed 2 New York, Springer, 2004. Vol 2.2:566606

    • Search Google Scholar
    • Export Citation
  • 2

    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
  • 3

    Cognard C, , Gobin YP, , Pierot L, , Bailly AL, , Hudart E, & Casasco A, et al.: Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194:671680, 1995

    • Search Google Scholar
    • Export Citation
  • 4

    Cognard C, , Januel AC, , Silva NA, & Tall P: Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol 29:235241, 2008

    • Search Google Scholar
    • Export Citation
  • 5

    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
  • 6

    Davies MA, , Terbrugge KG, , Willinsky R, & Wallace MC: The natural history and management of intracranial dural arteriovenous fistulae. Part II: aggressive lesions. Intervent Neuroradiol 3:303311, 1997

    • Search Google Scholar
    • Export Citation
  • 7

    Duffau H, , Lopes M, , Janosevic V, , Sichez JP, , Faillot T, & Capelle L: Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature. J Neurosurg 90:7884, 1999

    • Search Google Scholar
    • Export Citation
  • 8

    Houdart E, , Saint-Maurice JP, , Chapot R, , Ditchfield A, , Blanquet A, & Lot G, et al.: Transcranial approach for venous embolization of dural arteriovenous fistulas. J Neurosurg 97:280286, 2002

    • Search Google Scholar
    • Export Citation
  • 9

    Lasjaunias P, , Magufis A, , Goulao R, , Piske S, , Suthipongchai R, & Rodesch R, et al.: Anatomical aspects of dural arteriovenous shunts in children. Review of 29 cases. Intervent Neuroradiol 2:179191, 1996

    • Search Google Scholar
    • Export Citation
  • 10

    Leonardi M, , Barbara C, , Simonetti L, , Giardino R, , Nicoli Aldini N, & Fini M, et al.: Glubran 2: a new acrylic glue for neuroradiological endovascular use. Experimental study on animals. Intervent Neuroradiol 8:245250, 2002

    • Search Google Scholar
    • Export Citation
  • 11

    Mironov A: Selective transvenous embolization of dural fistulas without occlusion of the dural sinus. AJNR Am J Neuroradiol 19:389391, 1998

    • Search Google Scholar
    • Export Citation
  • 12

    Nelson PK, , Russell SM, , Woo HH, , Alastra AJ, & Vidovich DV: Use of a wedged microcatheter for curative transarterial embolization of complex dural arteriovenous fistulas; indication, endovascular technique, and outcome in 21 patients. J Neurosurg 98:498506, 2003

    • Search Google Scholar
    • Export Citation
  • 13

    Roy D, & Raymond J: The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40:11331141, 1997

    • Search Google Scholar
    • Export Citation
  • 14

    Sarma D, & ter Brugge KG: Management of intracranial dural arteriovenous shunts in adults. Eur J Radiol 46:206220, 2003

  • 15

    Satomi J, , van Dijk JM, , ter Brugge KG, , Willinsky RA, & Wallace MC: Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion. J Neurosurg 97:767770, 2002

    • Search Google Scholar
    • Export Citation
  • 16

    Urtasun F, , Biondi A, , Casasco A, , Houdart E, , Caputo N, & Aymard A, et al.: Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization. Radiology 199:209217, 1996

    • Search Google Scholar
    • Export Citation
  • 17

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

    • Search Google Scholar
    • Export Citation
  • 18

    Weber W, , Kis B, , Siekmann R, & Kuehne D: Endovascular treatment of intracranial arteriovenous malformations with onyx: technical aspects. AJNR Am J Neuroradiol 28:371377, 2007

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 791 279 34
Full Text Views 163 20 0
PDF Downloads 117 26 0
EPUB Downloads 0 0 0