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Original research
Endovascular management of anterior falcotentorial dural arteriovenous fistulas: importance of functionality of deep venous system and existence of accompanying choroidal arteriovenous malformation
  1. Civan Islak1,
  2. Omer Bagcilar2,
  3. Sebahat Nacar Dogan3,
  4. Bora Korkmazer1,
  5. Serdar Arslan1,
  6. Osman Kizilkilic1,
  7. Naci Kocer1
  1. 1Department of Radiology Division of Neuroradiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
  2. 2Department of Radiology, Silivri State Hospital, Istanbul, Turkey
  3. 3Department of Radiology, Gaziosmanpaşa Taksim Training and Research Hospital, Istanbul, Turkey
  1. Correspondence to Professor Civan Islak, Department of Radiology. Division of Neuroradiology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey; cislak{at}istanbul.edu.tr

Abstract

Background Anterior falcotentorial junction dural arteriovenous fistulas (AFDAVFs) are the most deeply located and most complex type of tentorial fistula due to their location and vascular anatomy. We aimed to make new angiographic definitions of AFDAVF nidus and functionality of the deep venous system of the brain and thereby provide a safer approach for endovascular treatment.

Methods We retrospectively examined 18 patients with AFDAVF who received endovascular treatment at our neuroradiology department between June 2002 and May 2019. Pre- and post-treatment clinical assessments were performed using the modified Rankin Scale. AFDAVF niduses were defined as mixed-type or pure-dural-type on the basis of whether choroidal arteriovenous malformation was coexisting or not, respectively. The deep venous system was denoted as functional or nonfunctional.

Results We included 13 men and 5 women (mean (range) age, 47.2 (31–62) years). We evaluated 15 patients with pure-dural-type AFDAVFs and three with mixed-type AFDAVFs. Complete occlusion of the fistula was achieved in 15/18 patients. Three patients had transient neurologic symptoms. In two patients these were due to mild thalamic ischemia and in the third patient was due to tectal venous ischemia, all in mixed-type AFDAVF. One patient also developed Parinaud syndrome due to compression of the tectal plate by a thrombosed large vein of Galen. No patients died or developed permanent morbidity.

Conclusion Evaluating AFDAVFs as described here using our new subtyping model will help improve analysis of the malformation and development of a safer endovascular strategy, and hence may prevent periprocedural complications and improve treatment safety.

  • intervention
  • vascular malformation
  • arteriovenous malformation
  • angiography
  • fistula

Data availability statement

In this retrospective cohort study, we used anonymized magnetic resonance, computed tomography, and angiographic images. According to our institute's policy, the data from the present work are available from the corresponding author on reasonable request.

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Data availability statement

In this retrospective cohort study, we used anonymized magnetic resonance, computed tomography, and angiographic images. According to our institute's policy, the data from the present work are available from the corresponding author on reasonable request.

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Footnotes

  • Contributors CI: conceptualization, methodology, interpretation of data, writing the draft, figure design. OB: investigation, data collection, writing the draft, figure design. SND: investigation, data collection, writing the draft. BK: investigation, data collection. SA: investigation, data collection. OK: methodology, critical review of the work, supervision, editing, validation, conceptualization. NK: methodology, critical review of the work, supervision, editing, validation, conceptualization.

  • 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.

  • Disclaimer CI is a co-founder of NDI inc., and has a consultancy agreement with MicroVention. NK has a consultancy and proctoring agreement with MicroVention.

  • Competing interests None declared.

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

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