Learning objectives
To show alternative vascular access for treatment of dural fistulas.
Background
Dural arteriovenous fistulas (DAVFs) are defined as abnormal vascular connections located in the dura mater.
Corresponding to 10-15% of total intracranial vascular malformations.
Usually the afferent arteries are dural and meningeal arteries.
Although when fistulas are very large there may be sequestration / contribution of pial arteries.
An unclear etiology:
- most are considered acquired lesions.
Secondary to head trauma,
surgery,
chronic infection and venous sinus thrombosis.
The common predisposing factor seems to be the venous sinus thrombosis.
- Venous thrombosis can generate venous hypertension...
Findings and procedure details
We report 3 cases.
The first case is a tentorial dural arteriovenous fistula.
Due to the complexity of the vascular access the fistula is embolized transcranially by accessing percutaneously with an abbocath through the transcalvarial-channel of the right occipital artery and then selectively catheterizing this artery (branch of the external carotid artery).
(from Figure 2 to Figure 19).
The second case is a cortical dural arteriovenous fistula (parallel to the superior sagittal sinus).
The fistula is embolized transcranially by accessing percutaneously with a winged infusion...
Conclusion
The use of alternative vascular access for endovascular treatment of dural fistulas is a good therapeutic option in cases where the classical vascular access are complex.
References
- J.
Ortega Quintanilla,
R.
F.
Ocete Pérez,
V.
Carnerero Herrera,
A.
González García,
I.
Gutiérrez Jarrín,
A.
Mayol Deyá; Sevilla/ES.
Fístulas Arteriovenosas Durales: Historia Natural,
diagnóstico,
caracterización y tratamiento.
Presentación Electrónica Educativa.
Poster no.: S-1516.
SERAM 2012.
- Steven Alatakis,
George Koulouris,
and Stephen Stuckey.
CT-Demonstrated Transcalvarial Channels Diagnostic of Dural Arteriovenous Fistula.
AJNR Am J Neuroradiol 26:2393–2396,
October 2005.
- Bae Ju Kwon,
Moon Hee Han,
Hyun-Seung Kang,
and Kee-Hyun Chang.
MR Imaging Findings of Intracranial Dural Arteriovenous Fistulas: Relations with Venous Drainage...