You are here

Article Text

Article menu

Download PDFPDF

Technical video
Ethmoidal dural arteriovenous fistulas: endovascular transvenous embolization technique
Free
  1. Jorge A Roa1,
  2. Guilherme Dabus2,
  3. Sudeepta Dandapat3,
  4. David Hasan4,
  5. Edgar A Samaniego5
  1. 1 Neurology and Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  2. 2 Interventional Neuroradiology and Neuroendovascularl Surgery, Miami Cardiac & Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
  3. 3 Neurology, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
  4. 4 Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  5. 5 Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Dr Edgar A Samaniego, Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52246, USA; edgarsama{at}gmail.com

https://doi.org/10.1136/neurintsurg-2019-015691

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Abstract

    Ethmoidal dural arteriovenous fistulas (dAVFs) are rare, accounting for 1–1.5% of all intracranial malformations.1 However, they may have angiographic features that increase the risk of rupture: cortical venous drainage, venous ectasia, venous stenosis and high arterial flow. If the dAVF has these angiographic features, treatment may be indicated regardless of the clinical presentation.2–4 In this neurosurgical endovascular video 1, we present two patients with high-flow ethmoidal dAVFs treated via transvenous endovascular approaches. The first case was successfully embolized without complications, whereas the second case was complicated with intraoperative rupture of a tortuous cortical draining vein. The transvenous endovascular approach may be a useful tool in treating these lesions; however, access and tortuosity of structures proximal to the fistula point have to be thoroughly assessed. We review the natural history and angio-architecture of these lesions.5–7 Important tips and bailout maneuvers for treatment of complex ethmoidal dAVFs in eloquent locations are also presented.

    Video 1

    Video highlights

    • Introduction: 00:04

    • Angio-architecture: 00:18

    • Natural history: 01:23

    • Case 1:

      • Clinical presentation: 01:54

      • Jugular puncture: 02:39

      • Transvenous access: 03:30

      • Successful endovascular embolization: 04:30

      • Post-embolization angiography: 04:56

    • Case 2:

      • Clinical presentation: 05:16

      • Transvenous access: 06:19

      • Draining vein rupture: 06:38

      • Hemicraniectomy + subdural hematoma evacuation + microsurgical dAVF excision: 07:14

      • Follow-up angiography: 07:26

    • Summary/highlights: 07:39

    • References: 08:20

    References

    1. ↵
      2. Giannopoulos S ,
      3. Texakalidis P ,
      4. Mohammad Alkhataybeh RA , et al
      . Treatment of ethmoidal dural arteriovenous fistulas: a meta-analysis comparing endovascular versus surgical treatment. World Neurosurg 2019;128:593–9.doi:10.1016/j.wneu.2019.04.227
      OpenUrlPubMed
    2. ↵
      2. Defreyne L ,
      3. Vanlangenhove P ,
      4. Vandekerckhove T , et al
      . Transvenous embolization of a dural arteriovenous fistula of the anterior cranial fossa: preliminary results. AJNR Am J Neuroradiol 2000;21:761–5.
      OpenUrlAbstract/FREE Full Text
    3. ↵
      2. Samaniego EA ,
      3. Fisher M ,
      4. Hasan D , et al
      . Embolization of palpebral and orbito-frontal fistulas: technical and anatomical considerations in treating high-flow superficial skin lesions with liquid embolics. J Neurointerv Surg 2018;10:240–4.doi:10.1136/neurintsurg-2017-013239
      OpenUrlAbstract/FREE Full Text
    4. ↵
      2. Robert T ,
      3. Blanc R ,
      4. Smajda S , et al
      . Endovascular treatment of cribriform plate dural arteriovenous fistulas: technical difficulties and complications avoidance. J Neurointerv Surg 2016;8:954–8.doi:10.1136/neurintsurg-2015-011956
      OpenUrlAbstract/FREE Full Text
    5. ↵
      2. Spiotta AM ,
      3. Hawk H ,
      4. Kellogg RT , et al
      . Transfemoral venous approach for Onyx embolization of anterior fossa dural arteriovenous fistulae. J Neurointerv Surg 2014;6:195–9.doi:10.1136/neurintsurg-2012-010642
      OpenUrlAbstract/FREE Full Text
    6. ↵
      2. Inoue A ,
      3. Tagawa M ,
      4. Kumon Y , et al
      . Ethmoidal dural arteriovenous fistula with unusual drainage route treated by transarterial embolization. J Neurointerv Surg 2015;7:e15.doi:10.1136/neurintsurg-2013-011098.rep
    7. ↵
      2. Lekkhong E ,
      3. Pongpech S ,
      4. Ter Brugge K , et al
      . Transvenous embolization of intracranial dural arteriovenous shunts through occluded venous segments: experience in 51 patients. AJNR Am J Neuroradiol 2011;32:1738–44.doi:10.3174/ajnr.A2566
      OpenUrlAbstract/FREE Full Text

    Footnotes

    • Twitter @jorge_roa93

    • Contributors EAS and JAR: manuscript and technical video preparation, guarantors of the study; GD, SD and DMH: critical revision of contents.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests GD is a consultant for Medtronic, Microvention, Penumbra, and Cerenovus. EAS is a consultant for Microvention, Medtronic, and Shape Medical.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.