Top

Neuroradiology

Published in:

01-07-2009 | Interventional Neuroradiology

Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients

Authors: M. Kirsch, T. Liebig, D. Kühne, H. Henkes

Published in: Neuroradiology | Issue 7/2009

Abstract

Introduction

This study aimed to evaluate the safety and efficiency of the endovascular treatment of transverse–sigmoid sinus dural arteriovenous fistulas (TS_dAVF).

Methods

A total of 150 consecutive patients and 348 procedures were evaluated.

Results

Pulsatile tinnitus (81%), headache (15%), and intracranial hemorrhage (10%) were the most frequent manifestations of the TS_dAVFs. More than half of the affected sinuses were partially or completely thrombosed. Access-wise treatment was performed transarterial (n = 33), transvenous (n = 21), or a combination thereof (n = 96). A mean of 2.4 procedures per patient was required. Immediate postprocedural occlusion rate after transarterial embolization was 30% only. Transvenous treatment alone resulted in an early occlusion rate of 81%, with delayed complete obliteration of half of the remaining fistulas. After combined transarterial/transvenous treatment, the angiographic cure rate was 54%. At follow-up, 88% of patients with residual shunt after the treatment showed complete occlusion. The cumulative complication rate was 9% (n = 13), with minor adverse events in ten patients (7%) and major complications in three patients (2%).

Conclusion

Transvenous coil occlusion of the sinus segment with the adjacent dAVF site, eventually combined with transarterial occlusion of supplying arteries, is a very effective and well-tolerated treatment method. In selected patients, variations of these methods (e.g., sinus stenting, compartmental sinus occlusion) can be useful.

Awad IA, Little JR, Akarawi WP, Ahl J (1990) Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72:839–850PubMedCrossRef

Barnwell SL, Halbach VV, Higashida RT, Hieshima G, Wilson CB (1989) Complex dural arteriovenous fistulas. Results of combined endovascular and neurosurgical treatment in 16 patients. J Neurosurg 71:352–358PubMedCrossRef

Brasse G, Roth HJ, Fritzsch D, Scheid R (2009) Now you see it, now you don't—the hidden life of cerebral dural arteriovenous fistulae. Neuroradiology 51:131–133PubMedCrossRef

Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, Chiras J, Merland JJ (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194:671–680PubMed

Cognard C, Januel AC, Silva NA Jr, Tall P (2008) Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using onyx. AJNR Am J Neuroradiol 29:235–241PubMedCrossRef

da Costa LB, Terbrugge K, Farb R, Wallace MC (2007) Surgical disconnection of cortical venous reflux as a treatment for Borden type II dural arteriovenous fistulae. Acta Neurochir (Wien) 149:1103–1108CrossRef

Davies MA, TerBrugge K, Willinsky R, Coyne T, Saleh J, Wallace MC (1996) The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 85:830–837PubMedCrossRef

Dawson RC 3rd, Joseph GJ, Owens DS, Barrow DL (1998) Transvenous embolization as the primary therapy for arteriovenous fistulas of the lateral and sigmoid sinuses. AJNR Am J Neuroradiol 19:571–576PubMed

Debrun GM, Vinuela F, Fox AJ, Davis KR, Ahn HS (1988) Indications for treatment and classification of 132 carotid-cavernous fistulas. Neurosurgery 22:285–289PubMedCrossRef

10.

Endo S, Kuwayama N, Takaku A, Nishijima M (1998) Direct packing of the isolated sinus in patients with dural arteriovenous fistulas of the transverse–sigmoid sinus. J Neurosurg 88:449–456PubMed

11.

Fok KF, Agid R, Souza MPS, terBrugge KG (2004) Thrombosis of aggressive dural arteriovenous fistula after incomplete embolization. Neuroradiology 46:1016–1021PubMedCrossRef

12.

Gobin YP, Houdart E, Rogopoulos A, Casasco A, Bailly AL, Merland JJ (1993) Percutaneous transvenous embolization through the thrombosed sinus in transverse sinus dural fistula. AJNR Am J Neuroradiol 14:1102–1105PubMed

13.

Goto K, Sidipratomo P, Ogata N, Inoue T, Matsuno H (1999) Combining endovascular and neurosurgical treatments of high-risk dural arteriovenous fistulas in the lateral sinus and the confluence of the sinuses. J Neurosurg 90:289–299PubMedCrossRef

14.

Halbach VV, Higashida RT, Hieshima GB, Goto K, Norman D, Newton TH (1987) Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients. Radiology 163:443–447PubMed

15.

Halbach VV, Higashida RT, Hieshima GB, Mehringer CM, Hardin CW (1989) Transvenous embolization of dural fistulas involving the transverse and sigmoid sinuses. AJNR Am J Neuroradiol 10:385–392PubMed

16.

Halbach VV, Higashida RT, Hieshima GB, Wilson CB, Hardin CW, Kwan E (1989) Treatment of dural fistulas involving the deep cerebral venous system. AJNR Am J Neuroradiol 10:393–399PubMed

17.

He HW, Jiang CH, Wu ZX, Li YX, Lü XL, Wang ZC (2008) Transvenous embolization with a combination of detachable coils and onyx for a complicated cavernous dural arteriovenous fistula. Chin Med J (Engl) 121:1651–1655

18.

Jiang C, Lv X, Li Y, Zhang J, Wu Z (2009) Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes. Neuroradiology 51:103–111PubMedCrossRef

19.

Kakarla UK, Deshmukh VR, Zabramski JM, Albuquerque FC, McDougall CG, Spetzler RF (2007) Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications. Neurosurgery 61:447–457PubMedCrossRef

20.

Kataoka K, Taneda M (1984) Angiographic disappearance of multiple dural arteriovenous malformations. Case report. J Neurosurg 60:1275–1278PubMedCrossRef

21.

Kawaguchi S, Sakaki T, Morimoto T, Hoshida T, Nakase H (2000) Surgery for dural arteriovenous fistula in superior sagittal sinus and transverse sigmoid sinus. J Clin Neurosci 7(Suppl 1):47–49PubMed

22.

Kim MS, Han DH, Kwon OK, Oh CW, Han MH (2002) Clinical characteristics of dural arteriovenous fistula. J Clin Neurosci 9:147–155PubMedCrossRef

23.

King WA, Martin NA (1992) Intracerebral hemorrhage due to dural arteriovenous malformations and fistulae. Neurosurg Clin N Am 3:577–590PubMed

24.

Kiyosue H, Hori Y, Okahara M, Tanoue S, Sagara Y, Matsumoto S, Nagatomi H, Mori H (2004) Treatment of intracranial dural arteriovenous fistulas: current strategies based on location and hemodynamics, and alternative techniques of transcatheter embolization. Radiographics 24:1637–1653PubMedCrossRef

25.

Landman JA, Braun IF (1985) Spontaneous closure of a dural arteriovenous fistula associated with acute hearing loss. AJNR Am J Neuroradiol 6:448–449PubMed

26.

Liebig T, Henkes H, Brew S, Miloslavski E, Kirsch M, Kühne D (2005) Reconstructive treatment of dural arteriovenous fistulas of the transverse and sigmoid sinus: transvenous angioplasty and stent deployment. Neuroradiology 47:543–551PubMedCrossRef

27.

Link MJ, Coffey RJ, Nichols DA, Gorman DA (1996) The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas. J Neurosurg 84:804–809PubMedCrossRef

28.

Luciani A, Houdart E, Mounayer C, Saint Maurice JP, Merland JJ (2001) Spontaneous closure of dural arteriovenous fistulas: report of three cases and review of the literature. AJNR Am J Neuroradiol 22:992–996PubMed

29.

Mironov A (1995) Selective transvenous embolization of dural fistulas without occlusion of the dural sinus. AJNR Am J Neuroradiol 19:389–391

30.

Mullan S, Johnson DL (1995) Combined sagittal and lateral sinus dural fistulae occlusion. J Neurosurg 82:159–165PubMedCrossRef

31.

Murphy KJ, Gailloud P, Venbrux A, Deramond H, Hanley D, Rigamonti D (2000) Endovascular treatment of a grade IV transverse sinus dural arteriovenous fistula by sinus recanalization, angioplasty, and stent placement: technical case report. Neurosurgery 46:497–501PubMedCrossRef

32.

Nelson PK, Russell SM, Woo HH, Alastra AJ, Vidovich DV (2003) 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 98:498–506PubMedCrossRef

33.

Newton TH, Cronqvist S (1969) Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93:1071–1078PubMed

34.

Nogueira RG, Dabus G, Rabinov JD, Eskey CJ, Ogilvy CS, Hirsch JA, Pryor JC (2008) Preliminary experience with onyx embolization for the treatment of intracranial dural arteriovenous fistulas. AJNR Am J Neuroradiol 29:91–97PubMedCrossRef

35.

O'Leary S, Hodgson TJ, Coley SC, Kemeny AA, Radatz MWR (2002) Intracranial dural arteriovenous malformations: results of stereotactic radiosurgery in 17 patients. Clin Oncol (R Coll Radiol) 14:97–102

36.

Olutola PS, Eliam M, Molot M, Talalla A (1983) Spontaneous regression of a dural arteriovenous malformation. Neurosurgery 12:687–690PubMedCrossRef

37.

Pan DH, Chung W, Guo W, Wu H, Liu K, Shiau C, Wang L (2002) Stereotactic radiosurgery for the treatment of dural arteriovenous fistulas involving the transverse–sigmoid sinus. J Neurosurg 96:823–829PubMedCrossRef

38.

Panagiotopoulos V, Möller-Hartmann W, Asgari S, Sandalcioglu IE, Forsting M, Wanke I (2009) Onyx embolization as a first line treatment for intracranial dural arteriovenous fistulas with cortical venous reflux. Fortschr Röntgenstr 181:129–138CrossRef

39.

Sundt TM Jr, Nichols DA, Piepgras DG, Fode NC (1991) Strategies, techniques, and approaches for dural arteriovenous malformations of the posterior dural sinuses. Clin Neurosurg 37:155–170PubMed

40.

Thompson BG, Doppman JL, Oldfield EH (1994) Treatment of cranial dural arteriovenous fistulae by interruption of leptomeningeal venous drainage. J Neurosurg 80:617–623PubMedCrossRef

41.

Urtasun F, Biondi A, Casaco A, Houdart E, Caputo N, Aymard A, Merland JJ (1996) Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization. Radiology 199:209–217PubMed

42.

Wong GKC, Poon WS, Yu SCH, Zhu CXL (2007) Transvenous embolization for dural transverse sinus fistulas with occluded sigmoid sinus. Acta Neurochir (Wien) 149:929–935CrossRef

Title: Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients
Authors: M. Kirsch
T. Liebig
D. Kühne
H. Henkes
Publication date: 01-07-2009
Publisher: Springer-Verlag
Published in: Neuroradiology / Issue 7/2009
Print ISSN: 0028-3940
Electronic ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-009-0524-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2009

European Society of Neuroradiology (ESNR)

Cranial nerve assessment in cavernous sinus tumors with contrast-enhanced 3D fast-imaging employing steady-state acquisition MR imaging

Automated versus manual post-processing of perfusion-CT data in patients with acute cerebral ischemia: influence on interobserver variability

Vertebroplasty as treatment of aggressive and symptomatic vertebral hemangiomas: up to 4 years of follow-up

The venous hinge—an objective sign for the diagnosis and follow-up of treatment in patients with intracranial hypotension syndrome

Simple and complex dysembryoplastic neuroepithelial tumors (DNT) variants: clinical profile, MRI, and histopathology