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E-038 Utility of Dyna CT in the evaluation and management of cranial and skull base arteriovenous fistulas
  1. D Gandhi1,
  2. J Huang2,
  3. J Gomez3,
  4. S Kathuria1
  1. 1Radiology, Neurosurgery, Neurology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
  2. 2Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
  3. 3Radiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA


Introduction Intracranial dural arteriovenous fistulas (dAVFs) are comprised of pathologic, dural based shunts and account for 10–15% of all intracranial arteriovenous malformations. These lesions have complex anatomy that is best studied with conventional digital subtraction angiography (DSA). Conventional DSA is however limited by its planar imaging nature. A more detailed analysis of these lesions is now possible with cone beam CT. We present our initial experience with 10 patients of dAVFs studied with C arm CT.

Methods This study includes 10 patients with intracranial and skull base dAVFs that were evaluated with conventional DSA and a C arm CT (Dyna CT) between January 2009 and February 2010 by one of the authors (DG). The DSA evaluation included selected catheter angiograms of bilateral common, internal, external carotid and vertebral arteries. Additional Dyna CT evaluation was accomplished while injecting diluted contrast into the dominant feeding artery. MPRs were performed by using an external postprocessing workstation (syngoXWorkplace; Siemens Medical Solutions) to produce section thickness of 0.2–0.5 mm. This study is a retrospective review of patient charts, imaging studies and DSA/C arm CT evaluations.

Results C arm CT was successfully performed on all patients and provided excellent quality images. The anatomic understanding of the osteodural network, location of arteriovenous shunt and venous compartment was aided by Dyna CT and significantly added to the understanding of these lesions. In addition, there were additional findings noted on Dyna CT that had significant impact on management of four of 10 patients. The final management included endovascular treatment exclusively in 5/10, combination of embolization and surgery in 1/10 and embolization followed by gamma knife in 1/10. Three of 10 patients are being managed conservatively in view of Borden type 1 fistulae that were minimally symptomatic.

Conclusion C arm CT is complementary to DSA in the evaluation of cranial and skull base dAVFs. In many patients, Dyna CT provides information that is difficult to obtain from conventional DSA. In our initial experience, Dyna CT had a significant impact in the management of these lesions.

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  • Competing interests None.