Skip to main content

Advertisement

Log in

Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Introduction

An increasing number of intracranial dural arteriovenous fistulas (DAVFs) are amenable to endovascular treatment with Onyx-18. We reviewed our experience with the endovascular management of tentorial dural arteriovenous fistulas (TDAVFs) treated transarterially and transvenously.

Materials and methods

Clinical records for 19 consecutive patients (three women, 16 men) with TDAVFs treated endovascularly between 2005 and 2008 were reviewed to determine their presenting symptoms, angiographic features, endovascular treatments, and clinical outcomes. Most patients (78.9%) presented with intracranial hemorrhage (ICH). All patients had high-risk angiographic features such as leptomeningeal venous varix.

Results

Transarterial embolization was performed in 19 patients. Transvenous embolization was additionally performed in two patients and caused one death. At the time of the last follow-up evaluation, 16 (84.2%) patients had good or excellent outcomes (modified Rankin score, 0 or 1) and one (5.3%) was deceased. Six patients had a residual fistula and were treated with gamma knife radiosurgery. The overall morbidity and mortality rate was 10.5%.

Conclusion

High-risk TDAVFs can be successfully managed with good outcomes. When anatomic features can be accessed endovascularly, endovascular treatment is indicated. Patients with residual filling of the DAVF should be considered for adjuvant therapy, including further radiosurgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Anil A, Servet I (2006) Treatment of a superior sagittal sinus dural arteriovenous fistula with Onyx: technical case report. Neurosurgery 59(1):169–170

    Google Scholar 

  2. Benndorf G, Schmidt S, Sollman WP, Kroppenstedt SN (2003) Tentorial dural arteriovenous fistula presenting with various visual symptoms related to anterior and posterior visual pathway dysfunction: case report. Neurosurgery 53:222–227, doi:10.1227/01.NEU.0000068873.63576.5E

    Article  PubMed  Google Scholar 

  3. Brano G, Takahashi A, Ezura M, Yoshida M, Yoshimoto T (1997) Dural arteriovenous shunt involving the superior petrosal sinus: presentation and treatment by transvenous embolization via the occipital and transverse sinuses. Neuroradiology 39:67–70, doi:10.1007/s002340050369

    Article  Google Scholar 

  4. Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, Chiras J, Merlland JJ (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194:671–680

    PubMed  CAS  Google Scholar 

  5. Dagcinar A, Kaya AH, Aydin ME, Kopuz C, Senel A, Demir AT, Corumlu U, Celik F, Sam B (2007) The superior cerebellar artery: anatomic study with review. Neurosurg Q 17(3):235–240, doi:10.1097/WNQ.0b013e31806453ae

    Article  Google Scholar 

  6. Deasy NP, Gholkar AR, Cox TCS, Jeffree MA (1999) Tentorial dural arteriovenous fistulae: endovascular treatment with transvenous coil embolization. Neuroradiology 41:308–312, doi:10.1007/s002340050754

    Article  PubMed  CAS  Google Scholar 

  7. de Haan R, Limburg M, Bossuyt P, van der MJ, Aaronson N (1995) The clinical meaning of Rankin ‘handicap’ grades after stroke. Stroke 26:2027–2030

    PubMed  Google Scholar 

  8. Deshmukh VR, Maughan PH, Spetzler RF (2006) Resolution of hemifacial spasm after surgical obliteration of a tentorial arteriovenous fistula: case report. Neurosurgery 58(1):E202, doi:10.1227/01.NEU.0000192386.89105.82

    Article  PubMed  Google Scholar 

  9. Fujita A, Tamaki N, Nakamura M, Yosuo K, Morikawa M (2001) A tentorial dural arteriovenous fistula successfully treated with interruption of leptomeningeal venous drainage using microvascular Doppler sonography: case report. Surg Neurol 56:56–61, doi:10.1016/S0090-3019(01)00492-X

    Article  PubMed  CAS  Google Scholar 

  10. Halbach VV, Higashida RT, Hieshima GB, Hardin CW (1989) Embolization of branches arising from the cavernous portion of the internal carotid artery. AJNR Am J Neuroradiol 10:143–150

    PubMed  CAS  Google Scholar 

  11. Iwamuro Y, Nakahara I, Higashi T, Iwaasa M, Watanabe Y, Hirata E, Tsunetoshi K, Taha M (2006) Tentorial dural arteriovenous fistula presenting symptoms due to mass effect on the dilated draining vein: case report. Surg Neurol 65:511–515, doi:10.1016/j.surneu.2005.07.076

    Article  PubMed  Google Scholar 

  12. Jesus OD, Rosado JE (1999) Tentorial dural arteriovenous fistula obliteration using the petrosal approach. Surg Neurol 51:164–167, doi:10.1016/S0090-3019(97)00414-X

    Article  PubMed  Google Scholar 

  13. Jiang C, Lv X, Li Y, Wu Z (2007) Transarterial and transvenous embolization for tentorial dural arteriovenous fistula: case report. AJNR Am J Neuroradiol 20(6):726–729

    Google Scholar 

  14. Kajita Y, Miyachi S, Wakabayashi T, Inao S, Yoshida J (1999) A dural arteriovenous fistula of the tentorium successfully treated by intravascular embolization. Surg Neurol 52:294–298, doi:10.1016/S0090-3019(99)00076-2

    Article  PubMed  CAS  Google Scholar 

  15. Kim MS, Han DH, Han MH, Oh C-W (2003) Posterior fossa hemorrhage caused by dural arteriovenous fistula: case reports. Surg Neurol 59:512–517, doi:10.1016/S0090-3019(03)00077-6

    Article  PubMed  Google Scholar 

  16. Lasjaunias PL (1984) Anatomy of the tentorial arteries. Neurosurgery 61:1159–1160

    CAS  Google Scholar 

  17. Lv X, Li Y, Liu A, Jiang C, Wu Z (2007) Transarterial embolization of dural arteriovenous fistulas of the anterior cranial fossa Onyx-18: case report. AJNR Am J Neuroradiol 20(3):53–59

    Google Scholar 

  18. Lv X, Li Y, Lv M, Liu A, Zhang J, Wu Z (2007) Trigeminocardiac reflex in embolization of intracranial dural arteriovenous fistula. AJNR Am J Neuroradiol 28:1769–1770, doi:10.3174/ajnr.A0675

    Article  PubMed  CAS  Google Scholar 

  19. Lv XL, Li YX, Liu AH, Lv M, Jiang P, Zhang JB, Wu ZX (2008) A complex cavernous sinus dural arteriovenous fistula secondary to covered stent placement for a traumatic carotid artery-cavernous sinus fistula. J Neurosurg 108(3):588–590, doi:10.3171/JNS/2008/108/3/0588

    Article  PubMed  Google Scholar 

  20. Lv X, Jiang C, Li Y, Yang X, Wu Z (2008) Transarterial embolization of tentorial dural arteriovenous fistulas with Onyx-18. AJNR Am J Neuroradiol 21:406–414

    Google Scholar 

  21. Masahiro S, Hiroki K, Masao T, Takaaki K (2000) Stereotactic radiosurgery for tentorial dural arteriovneous fistulae draining into the vein of Galen: reports of two cases. Neurosurgery 46(3):730, doi:10.1097/00006123-200003000-00039

    Article  Google Scholar 

  22. Matsushige T, Nakaoka M, Ohta K, Yahara K, Okamotor H, Kurisu K (2006) Tentorial dural arteriovenous malformation manifesting as trigeminal neuralgia treated by stereotactic radiosurgery: a case report. Surg Neurol 66:519–523, doi:10.1016/j.surneu.2006.01.022

    Article  PubMed  Google Scholar 

  23. Murakami T, Ono Y, Akagi N, Oshima E, Hamakawa Y, Omori N (2005) A case of superior cerebellar artery syndrome with contralateral hearing loss at onset. J Neurol Neurosurg Psychiatry 76:1744, doi:10.1136/jnnp.2004.058735

    Article  PubMed  CAS  Google Scholar 

  24. Pannu Y, Shownkeen H, Nockels RP, Origitano TC (2004) Obliteration of a tentorial dural arteriovenous fistula causing spinal cord myelopathy using the cranio-orbital zygomatic approach. Surg Neurol 62:463–467, doi:10.1016/j.surneu.2004.01.017

    Article  PubMed  Google Scholar 

  25. Patrik RT, Harry JC, Akihiko K, Micheal CC, Jacques D, Daniel LB (2003) Evolution of the management of tentorial dural arteriovenous malformations. Neurosurgery 52(4):750–762

    Google Scholar 

  26. Paula-Lucas C, Pereica-Caldas J-G-M, Prandini MN (2006) Do leptomeningeal venous drainage and dysplastic venous dilation predict hemorrhage in dural arteriovenous fistula? Surg Neurol 66(Suppl 3):S2–S5

    Article  Google Scholar 

  27. Picard L, Bracard S, Islak C, Roy D, Moreno A, Marchal JC, Roland J (1990) Dural fistulae of the tentorium cerebelli. Radioanatomical, clinical and therapeutic considerations. J Neuroradiol 17:161–181

    PubMed  CAS  Google Scholar 

  28. Reisch R, Vutskits L, Patonay L, Fries G (1996) The meningohypophyseal trunk and its blood supply to different intracranial structures. An anatomical study. Minim Invasive Neurosurg 39:78–81

    Article  PubMed  CAS  Google Scholar 

  29. Rezende MTS, Poitin M, Mounayer C, Spelle L, Abud DG, Moret J (2006) Dural arteriovenous fistula of the lesser sphenoid wing region treated with Onyx: technical note. Neuroradiology 48:130–134, doi:10.1007/s00234-005-0020-9

    Article  PubMed  Google Scholar 

  30. Schaller B, Probster R, Strebal S, Gratzl O (1999) Trigemino-cardiac reflex during surgery in the cerebellopontine angle. J Neurosurg 90:215–220

    PubMed  CAS  Google Scholar 

  31. Terao S, Sobue G, Izumi M, Miura N, Takeda A, Mitsuma T (1996) Infarction of superior cerebellar artery presenting as cerebellar symptoms. Stroke 27:1679–1681

    PubMed  CAS  Google Scholar 

  32. Sohn S, Lee H, Lee SR, Baloh RW (2006) Cerebellar infarction in the territory of the medial branch of the superior cerebellar artery. Neurology 66:115–117, doi:10.1212/01.wnl.0000191389.81651.de

    Article  PubMed  Google Scholar 

  33. Troffkin NA, Graham CB, Berkman T, Wakhloo AK (2003) Combined transvenous and trans arterial embolization of a tentorial–incisural dural arteriovenous malformation followed by primary stent placement in the associated stenotic straight sinus. Case report. J Neurosurg 99(3):579–583

    PubMed  Google Scholar 

  34. van Rooij WJ, Sluzewski M, Beute GN (2006) Tentorial artery embolization in tentorial dural arteriovenous fistulas. Neuroradiology 48:737–743, doi:10.1007/s00234-006-0118-8

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Zhongxue Wu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jiang, C., Lv, X., Li, Y. et al. Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes. Neuroradiology 51, 103–111 (2009). https://doi.org/10.1007/s00234-008-0473-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-008-0473-8

Keywords

Navigation