The authors present a case of isolated dural arteriovenous fistula (DAVF) in the transverse sinus, which developed six years after microvascular decompression caused by hemifacial spasm via suboccipital craniectomy. The lesion was successfully treated by transarterial embolization using Onyx. We reviewed the related radiologic and therapeutic features of DAVF involving an isolated sinus and described the feasibility of the use of Onyx.
Central Nervous System Vascular Malformations ; Hemifacial Spasm ; Microvascular Decompression Surgery

Aged ; Central Nervous System Vascular Malformations ; diagnosis ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Spinal Cord ; blood supply

Adult ; Aged ; Central Nervous System Vascular Malformations ; diagnostic imaging ; surgery ; Female ; Humans ; Laminectomy ; methods ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Treatment Outcome

Hypothermia and cardiopulmonary bypass has been used for difficult lesions of the brain such as giant aneurysms. We reported a case of complex intracranial dural arteriovenous fistula (DAVF) undergoing surgery with deep hypothermic circulatory arrest (DHCA). The advantages and disadvantages of this operation were discussed. This is the first report describing the use of DHCA in the surgical management of complex intracranial DAVF. We also reviewed the literature documenting the treatment of DAVF and the history of deep hypothermia and circulatory arrest in cerebrovascular surgery.
Adolescent ; Angiography, Digital Subtraction ; Central Nervous System Vascular Malformations ; diagnostic imaging ; surgery ; Circulatory Arrest, Deep Hypothermia Induced ; Humans ; Male ; Neurosurgical Procedures ; methods

OBJECTIVE: To compare the clinical effect of microsurgery and endovascular embolization in the treatment of spinal dural arteriovenous fistula (SDAVF) by meta-analysis. METHODS: A systematic review was performed to retrieve all relevant literature about surgical treatment or endovascular embolization of SDAVF up to December 2019 through PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials Results, CNKI, Wanfang Data, and SinoMed. The Chinese and English key words included: "SDAVF", "spinal dural arteriovenous fistula", "spinal AVM", "spinal vascular malformation and treatment". The included studies were evaluated using the Newcastle-Ottawa scale. The early failure rate, long-term recurrence, neurological recovery, and complications were evaluated and the clinical effects of the two methods in the treatment of SDAVF were compared by using RevMan 5.3 software. And a further subgroup analysis of the therapeutic effect of endovascular embolization with different embolic agents was conducted. RESULTS: A total of 46 studies involving 1 958 cases of SDAVF were included, in which 935 cases were treated by microsurgery and 1 023 cases were treated by endovascular embolization. The funnel plot demonstrated that there was no publication bias. The results of meta-analysis showed that the incidence of early surgical failure was lower than that of endovascular embolization (OR=0.20, 95%CI: 0.13-0.30, P < 0.05), and the long-term recurrence was also lower than that of endovascular embolization (OR=0.36, 95%CI: 0.22-0.58, P < 0.05). The improvement of neurological function in the surgical patients is significantly higher than that in the patients treated with endovascular embolization (OR=2.86, 95%CI: 1.36-5.99, P < 0.05). There was no significant difference in the occurrence of complications in these two groups (OR=1.52, 95%CI: 0.88-2.64, P=0.14). In the cases of endovascular embolization, the risk of treatment failure or recurrence was higher with Onyx glue than with n-butyl 2-cyanoacrylate (NBCA), and the difference was statistically significant (OR=4.70, 95%CI: 1.55-14.28, P < 0.05). CONCLUSION Although the treatment of dural arteriovenous fistulas by intravascular embolization has been widely used, the clinical effect of microsurgery is still better than that of endovascular embolization. Large scale and high-quality randomized controlled trials are required to validate the efficacy and safety of endovascular treatment in SDAVF patients.
Central Nervous System Vascular Malformations/surgery* ; Embolization, Therapeutic/methods* ; Enbucrilate/therapeutic use* ; Endovascular Procedures/methods* ; Humans ; Microsurgery/methods* ; Retrospective Studies ; Treatment Outcome

Dural arteriovenous fistula (AVF) is very rare, acquired lesion that may present with intracranial hemorrhage or neurological deficits. The etiology is not completely understood but dural AVF often has been associated with thrombosis of the involved dural sinuses. To our knowledge, this is the first well documented intracranial hemorrhage case caused by dural AVF following microvascular decompression for hemifacial spasm. A 49-year-old male patient had left microvascular decompression of anterior inferior cerebellar artery via retrosigmoid suboccipital craniotomy. The patient was in good condition without any residual spasm or surgery-related complications. However, after 10 months, he suffered sudden onset of amnesia and dysarthria. Computed tomography and magnetic resonance imaging revealed the presence of dural AVF around the left transverse-sigmoid sinus. The dural AVF was treated with Onyx(R) (ev3) embolization. At the one-year follow up visit, there were no evidence of recurrence and morbidity related to dural AVF and its treatment. This case confirms that the acquired etiology of dural AVF may be associated with retrosigmoid suboccipital craniotomy for hemifacial spasm, even though it is an extremely consequence of this procedure.
Amnesia ; Arteries ; Central Nervous System Vascular Malformations* ; Craniotomy ; Dysarthria ; Follow-Up Studies ; Hemifacial Spasm* ; Humans ; Intracranial Hemorrhages ; Magnetic Resonance Imaging ; Male ; Microvascular Decompression Surgery* ; Middle Aged ; Recurrence ; Spasm ; Thrombosis

PURPOSE: Magnetic resonance imaging (MRI) has been used to screen and follow-up spinal dural arteriovenous fistulae (SDAVF). The purpose of this study was to evaluate the association between MRI findings and neurologic function in SDAVF. This study also investigated clinical features and treatment results of SDAVF. MATERIALS AND METHODS: A total of 15 consecutive patients who underwent embolization or surgery for SDAVF were included. We treated seven (60%) patients with embolization and six (40%) with surgery. We analysed clinical features, MRI findings, treatment results, and neurologic function. Neurologic function was measured by the Aminoff-Logue disability scale (ALS). RESULTS: Patients with longer levels of intramedullary high signal intensity in preoperative T2-weighted images (T2WI) exhibited worse pre- and postoperative ALS scores (r=0.557, p=0.031; r=0.530, p=0.042, Pearson correlation). Preoperative ALS score was significantly correlated with postoperative ALS score (r=0.908, p=0.000, Pearson correlation). The number of levels showing intramedullary high signal intensity in T2WI decreased significantly postoperatively (5.2+/-3.1 vs. 1.0+/-1.4, p=0.001, Wilcoxon ranked test). CONCLUSION: The number of involved levels of high signal intensity in preoperative T2WI is useful for predicting pre- and postoperative neurologic function in SDAVF.
Adult ; Aged ; Angiography ; Arteriovenous Fistula/*pathology/radiography/*surgery ; Central Nervous System Vascular Malformations/*pathology/radiography/*surgery ; Embolization, Therapeutic/*methods ; Female ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Period ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Spinal Cord/abnormalities/*blood supply/pathology/surgery ; Treatment Outcome

PURPOSE: Magnetic resonance imaging (MRI) has been used to screen and follow-up spinal dural arteriovenous fistulae (SDAVF). The purpose of this study was to evaluate the association between MRI findings and neurologic function in SDAVF. This study also investigated clinical features and treatment results of SDAVF. MATERIALS AND METHODS: A total of 15 consecutive patients who underwent embolization or surgery for SDAVF were included. We treated seven (60%) patients with embolization and six (40%) with surgery. We analysed clinical features, MRI findings, treatment results, and neurologic function. Neurologic function was measured by the Aminoff-Logue disability scale (ALS). RESULTS: Patients with longer levels of intramedullary high signal intensity in preoperative T2-weighted images (T2WI) exhibited worse pre- and postoperative ALS scores (r=0.557, p=0.031; r=0.530, p=0.042, Pearson correlation). Preoperative ALS score was significantly correlated with postoperative ALS score (r=0.908, p=0.000, Pearson correlation). The number of levels showing intramedullary high signal intensity in T2WI decreased significantly postoperatively (5.2+/-3.1 vs. 1.0+/-1.4, p=0.001, Wilcoxon ranked test). CONCLUSION: The number of involved levels of high signal intensity in preoperative T2WI is useful for predicting pre- and postoperative neurologic function in SDAVF.
Adult ; Aged ; Angiography ; Arteriovenous Fistula/*pathology/radiography/*surgery ; Central Nervous System Vascular Malformations/*pathology/radiography/*surgery ; Embolization, Therapeutic/*methods ; Female ; Humans ; *Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Period ; Predictive Value of Tests ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Spinal Cord/abnormalities/*blood supply/pathology/surgery ; Treatment Outcome