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      Current status of endovascular treatment for dural arteriovenous fistulae in the anterior cranial fossa: A systematic literature review

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          Anterior cranial fossa (ACF) dural arteriovenous fistulae (DAVFs) are rare, and a systematic review of the literature is lacking. Such a review is necessary, however, so a systematic PubMed search of related studies was performed. Twenty-four studies were identified, reporting on 48 patients, of whom 39 had definite age and sex information and 33 (84.6%, 33/39) were male. The afflicted patients were between 37 and 80 years old (mean 55.6). Among the 48 patients, 28 (58.3%, 28/48) primarily presented with intracranial hemorrhage, 47 (97.9%, 47/48) had feeding arteries from the anterior ethmoidal artery (AEA) of the ophthalmic artery (OA), and 40 (83.3%, 40/48) had bilateral feeding arteries. All of the cases had high-grade Cognard classifications (III-IV). Among the 48 patients, 43 (89.6%, 43/48) had drainage into the superior sagittal sinus (SSS). In addition, 36 (75%, 36/48) patients were treated via transarterial embolization (TAE). Of these patients, 28 (77.8%, 28/36) were managed via the AEA of the OA. Another 12 (25%, 12/48) patients were treated via transvenous embolization (TVE), 11 of whom (91.7%, 11/12) were treated with the trans-SSS approach. Complete angiographic cure was achieved in 44 (91.7%, 44/48) patients, with 4 (8.3%, 4/48) patients suffering from postprocedural complications. All 48 patients had clear descriptions of follow-up outcomes, with 45 (93.8%, 45/48) patients having a good outcome. Thus, when treating ACF DAVFs, endovascular treatment (EVT) can completely obliterate the fistula point and correct the venous shunting. EVT is therefore an effective treatment for ACF DAVF. Although many complications can occur, this approach achieves good outcomes in most cases.

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          Treatment of intracranial dural arteriovenous fistulas: current strategies based on location and hemodynamics, and alternative techniques of transcatheter embolization.

          Intracranial dural arteriovenous fistulas (AVFs) can occur anywhere within the dura mater. Patients may be clinically asymptomatic or may experience symptoms ranging from mild symptoms to fatal hemorrhage, depending on the location (eg, cavernous sinus, transverse-sigmoid sinus, tentorium, superior sagittal sinus, anterior fossa) and venous drainage pattern of the AVF. In the past, dural AVFs have been treated with a variety of approaches, including surgical resection, venous clipping, transcatheter embolization, radiation therapy, or a combination of these treatments. Recent developments in catheter intervention now allow most patients to be cured with transcatheter embolization, although stereotactic radiation therapy is demonstrating good results in an increasing number of cases and surgery is still the preferred option in some cases. Familiarity with drainage patterns, the risk of aggressive symptoms, recent technical advances, and current treatment strategies is essential for the treatment of intracranial dural AVFs. (c) RSNA, 2004.
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            Ethmoidal dural arteriovenous fistulae: an assessment of surgical and endovascular management.

            Endovascular treatment of ethmoidal dural arteriovenous fistulae (DAVFs) has become technically feasible, but its relative risks and benefits have not justified its use. We present a series of patients with ethmoidal DAVFs treated almost exclusively with surgery at an institution where expert endovascular therapy was available. Surgical risks, treatment efficacy, and patient outcomes were determined for comparison with published endovascular data. Sixteen patients with ethmoidal DAVFs were treated during a 17-year period from 1982 to 1999. In three patients, feeding arteries from the internal maxillary artery were embolized; no ophthalmic artery embolizations were performed. A low bifrontal surgical approach was used in most patients to expose, coagulate, and divide the fistulous site. Ethmoidal DAVFs were occluded grossly and angiographically in all 16 patients. There was no treatment-associated neurological morbidity, and clinical outcomes were good in all but one patient who was comatose initially. Review of our surgical experience with ethmoidal DAVFs as well as published endovascular results for these lesions suggests that endovascular management of ethmoidal DAVFs has a small but clinically significant risk to vision, is rarely effective in curing the fistula, and does not eliminate the need for surgery. In contrast, surgical management has no associated risk to vision, is highly effective at obliterating the fistula, and can contribute to good clinical outcomes in most patients. For these reasons, surgical management of ethmoidal DAVFs remains the treatment of choice.
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              Management strategies for anterior cranial fossa (ethmoidal) dural arteriovenous fistulas with an emphasis on endovascular treatment.

              Dural arteriovenous fistulas (DAVFs) of the anterior cranial fossa are rare lesions that can cause intracranial hemorrhage. Authors of previous reports mostly have described open surgical treatment for this fistula type. The authors' purpose in the present study was to describe their experience with anterior cranial fossa DAVFs, including their endovascular treatment. All patients with anterior cranial fossa DAVFs diagnosed and treated in 3 separate institutions during the last 23 years were retrospectively identified. Clinical charts, imaging studies, and procedural notes were evaluated. Twenty-four patients (22 males and 2 females), ranging in age from 3 to 77 years, harbored 24 DAVFs in the anterior cranial fossa. Eleven patients were primarily treated with surgical disconnection and 2 with radiosurgery. Eleven patients were treated endovascularly; 7 of these patients (63.6%) were cured. In 4 cases of failed embolization, final disconnection was achieved through surgery. In fact, surgery was effective in disconnecting the fistula in 100% of cases. All endovascular procedures consisted of transarterial injections of diluted glue (N-butyl cyanoacrylate [NBCA]), and there were no complications. Brain edema developed around the venous pouch and confusion was apparent after venous disconnection in 1 surgically treated patient. No patient suffered a hemorrhage during the follow-up period. Disconnection of an anterior cranial fossa DAVF by using transarterial catheterization through the ophthalmic artery and subsequent injection of NBCA is possible with a reasonable success rate and low risk for complications. In patients with good vascular access this procedure could be the treatment of choice, to be followed by open surgery in cases of embolization failure.

                Author and article information

                Int J Med Sci
                Int J Med Sci
                International Journal of Medical Sciences
                Ivyspring International Publisher (Sydney )
                1 January 2019
                : 16
                : 2
                : 203-211
                [1 ]Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
                [2 ]Department of Radiology, The First Hospital of Jilin University, Changchun, 130021, China
                [3 ]Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, China
                Author notes
                ✉ Corresponding author: Department of Neurosurgery, The First Hospital of Jilin University, 71 Xinmin Avenue, Changchun 130021, China.

                *These authors contributed equally to this work.

                Competing Interests: The authors have declared that no competing interest exists.

                © Ivyspring International Publisher

                This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) license ( https://creativecommons.org/licenses/by-nc/4.0/). See http://ivyspring.com/terms for full terms and conditions.



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