Keywords:
Interventional vascular, Neuroradiology brain, Catheter arteriography, Catheter venography, Shunts, Embolisation, Arteriovenous malformations
Authors:
T. Dotsu1, H. Kiyosue1, Y. Hori1, S. Tanoue1, J. Kashiwagi1, R. Shimada2, Y. Sagara1, M. Okahara1, H. Mori1; 1Oita/JP, 2Yufu city/JP
DOI:
10.1594/ecr2013/C-1939
Methods and Materials
We retrospectively reviewed 6 consecutive patients with Borden type-3 SSS-DAVFs treated in our institutions between September 2002 and September 2012.
The clinical findings of the six patients are summarized in Table 1.
There were 3 males and 3 females,
with ages ranging from 71 to 86 years (mean age,
78.0).
Symptoms were headache (n=1),
cognitive disorder (n=2),
disturbance of consciousness (n=1),
hemiparalysis (n=1),
and cerebral hemorrhage (n=2).
Two patients had no symptoms.
One patient had a history of clipping for an anterior communicating artery aneurysm,
and one patient had a history of transvenous embolization for bilateral transverse sigmoid sinus (TSS) DAVFs.
Table 1: Symptoms and past history
|
Age/gender
|
Symptoms
|
Past history
|
1
|
86 F
|
cognitive disorder,ICH
|
post clipping for cerebral aneurysm
|
2
|
74 F
|
none
|
none
|
3
|
84 M
|
none
|
none
|
4
|
71 F
|
cognitive disorder,
headache
|
none
|
5
|
78 M
|
hemiparalysis,
ICH
|
none
|
6
|
75 M
|
disturbance of consciousness
|
bilateral CSH,
post TVE for bilateral TSS-DAVF,
post ligation of jugular vein
|
ICH,
intracranial hemorrhage; TVE,
transvenous embolization;
CSH,
chronic subdural hematoma;
TSS-DAVF,
transverse-sigmoid sinus dural arteriovenous fistula
All patients underwent selective cerebral angiography including biplane angiography and rotational angiography before endovascular treatment.
Angiographic features were reviewed by two neuroradiologists with a special interest in the main feeding arteries,
the presence of shunted pouch,
drainage routes of the DAVFs,
cerebral venous drainage from the affected areas of the brain,
restricted changes of the other venous sinuses,
and the coexistence of DAVFs in other locations.
A shunted pouch was defined as a tubular or elliptical vascular structure that is separated from the main sinus lumen into which multiple feeding arteries converge and continue to the SSS.
All patients underwent endovascular treatment under local anesthesia.
Selection of endovascular techniques was decided based on the angiographic features relating to occlusive changes in the other sinuses,
cerebral venous drainage from the affected areas of the brain,
accessibility to the shunted pouches,
and the feeding arteries.
Transarterial embolization was performed with a triple coaxial system (1.9F / 2.7F microcatheters and 5F guiding sheath,
or 1.5F microcatheter/ 4F support catheter/ 5F guiding sheath) via a femoral arterial approach,
while transvenous embolization was performed with a triple coaxial system (1.7 or 1.9F microcatheter and 4F support catheter) though 5F guiding sheath via a femoral venous approach.
After endovascular treatment,
all patients were followed up with angiography and/or MRA.
We reviewed the angiographic results immediately after treatment,
the complications,
and the follow-up results.