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Hemorrhagic stroke
Original research
Transarterial embolization for anterior cranial fossa dural arteriovenous fistulas: a retrospective single-center study
  1. Xin Su1,
  2. Zhenzhong Gao1,2,
  3. Yongjie Ma1,
  4. Zihao Song1,
  5. Hongqi Zhang1,
  6. Peng Zhang1,
  7. Ming Ye1
  1. 1 Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
  2. 2 Department of Neurosurgery, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan, China
  1. Correspondence to Dr Peng Zhang, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing 100053, China; zhangpengwr{at}126.com; Dr Ming Ye, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing 100053, China; yyneurosurgeon{at}163.com

Abstract

Background Clip ligation of anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs) is the traditionally accepted first-line treatment. Endovascular treatment for ACF DAVFs may achieve good outcomes as endovascular techniques advance. Here we report the clinical and angiographic outcomes in patients with ACF DAVFs who underwent transarterial embolization (TAE) as first-line treatment.

Methods Over a 20-year period, 87.0% (40/46) of patients received TAE as first-line treatment. The clinical presentation, angiographic features, treatment strategy, and clinical and angiographic outcomes are described in this article.

Results Forty patients underwent TAE as first-line treatment. There were 36 men and 4 women, with a mean age of 55.6 (55.6±7.4) years. A total of 64 embolization attempts were performed. The middle meningeal artery (66.7%, 12/18) and the ophthalmic artery (54.2%, 13/24) were the most frequently used arterial access routes for complete embolization. The second option was the sphenopalatine artery (46.7%, 7/15). Complications, that is, retinal ischemia, occurred in one patient (2.5%). The total immediate complete occlusion rate for TAE was 82.5% (33/40). Two patients needed surgery for incomplete embolization. When followed up (90%, 36/40), one patient (2.8%, 1/36) reported worsening symptoms due to retinal ischemia following TAE. Although fewer than 50% of the patients received digital subtraction angiography follow-up, there were no recurrences.

Conclusions We show that TAE is safe and effective in the treatment of ACF DAVFs in this study of 40 patients, making it a viable alternative to surgical ligation and transvenous embolization. More research is needed to compare these various treatment modalities.

  • Balloon
  • Catheter
  • Fistula
  • Hemorrhage
  • Technique

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/jnis-2023-020408

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • XS and ZG contributed equally.

    • Contributors Conception and design: XS, ZG, MY, PZ. Data acquisition: XS, YM, ZS. Drafting the article: XS, ZG. Critically revising the article: MY, PZ, HZ. Approval of final manuscript: all authors. Gaurantor of overall content: MY, PZ, HZ.

    • Funding This study was funded by the National Natural Science Foundation of China (No. 82101460). Role of the funding body: data collection.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.