Adult ; Dura Mater ; blood supply ; Humans ; Intracranial Arteriovenous Malformations ; complications ; diagnosis ; Male ; Tinnitus ; etiology

Drainage ; Dura Mater ; blood supply ; Humans ; Intracranial Arteriovenous Malformations ; diagnostic imaging ; surgery ; Male ; Meninges ; blood supply ; Middle Aged ; Radiography

We report a rare case of progressive myelopathy caused by intracranial dural arteriovenous fistula with venous drainage into the spinal perimedullary veins. A 45-yr-old man developed urinary and fecal incontinence and muscle weakness in the lower limbs. Magnetic resonance imaging revealed brainstem edema and dilated veins of the brainstem and spinal cord. Cerebral angiography showed a dural arteriovenous fistula fed by the neuromeningeal branch of the left ascending pharyngeal artery. Occlusion of the fistula could be achieved by embolization after a diagnostic and subsequent therapeutic delay. There was no improvement in clinical condition. For the neurologic outcome of these patients it is important that fistula must be treated before ischemic and gliotic changes become irreversible.
Spinal Cord Diseases/*etiology ; Middle Aged ; Male ; Magnetic Resonance Imaging ; Humans ; Dura Mater/*blood supply ; Arteriovenous Fistula/*complications/diagnosis

Adult ; Arteriovenous Fistula ; therapy ; Balloon Occlusion ; adverse effects ; Carotid-Cavernous Sinus Fistula ; therapy ; Cavernous Sinus ; abnormalities ; Dura Mater ; blood supply ; Humans ; Male ; Meningeal Arteries ; abnormalities

OBJECTIVESTo summarize the characteristics of interventional treatment of dural arteriovenous fistulae (DAVFs) and improve clinical curative effects.

METHODSThe clinical data from 135 patients with DAVFs were analyzed retrospectively.

RESULTSSeventy-four patients were cured, 53 were significantly improved, 8 unchange, and 1 died of intracranial haemorrhage.

CONCLUSIONSClinical presentations and prognosis of DAVF depend on the types of venous drainage. Compression of the affected carotid artery and endovascular embolization are safe and effective.

Adolescent ; Adult ; Aged ; Arteriovenous Fistula ; congenital ; diagnosis ; therapy ; Dura Mater ; blood supply ; Embolization, Therapeutic ; Female ; Humans ; Intracranial Arteriovenous Malformations ; diagnosis ; therapy ; Male ; Middle Aged

BACKGROUNDTreatment of cavernous dural arteriovenous fistulas (DAVF) is usually made by a transarterial approach. However, in many complicated patients, treatments via transarterial approaches can not be achieved, and only an operation via a transvenous approach is feasible. We aimed to study the feasibility of transarterial embolization of cavernous dural arteriovenous fistulas with a combination detachable coils and Onyx to embolize a complicated cavernous DAVF via a transvenous approach.

METHODSFrom August 2006 to August 2007, six cases of complicated cavernous DAVF were embolized with a combination of detachable coils and Onyx via a transvenous approach. Three cases were male and the other three were female. Their ages ranged from 36 to 69 years old. The fistula was in the right lateral cavernous sinus in one case, in the left lateral cavernous sinus in another, and in the bilateral cavernous sinus in 4 cases. One fistula was fed by the right internal carotid artery and its meningohypophyseal trunk; one was fed by the branches of the left internal carotid artery and left external carotid artery; four were fed by the branches of the bilateral internal carotid artery and/or the bilateral external carotid artery. One case was drained via one lateral inferior petrosal sinus; three were drained via bilateral inferior petrosal sinuses; one was drained via one lateral ophthalmic and facial veins; one was drained via the inferior petrosal sinus and the ophthalmic and facial veins. Four were embolized via the inferior petrosal sinus, and two were embolized via the ophthalmic and facial veins.

RESULTSAmong six cases of complicated cavernous DAVF, four were fully embolized with Onyx by a single operation, and two cases were fully embolized with Onyx following two operations. Transient headache was found after operation in all patients, but was cured after several days by the symptomatic treatments. In one case, the first operation via the inferior petrosal sinus was a failure; the feeding branches of the external carotid artery were embolized, and transient facial palsy was appeared after operation. The fistula was fully embolized with Onyx via the inferior petrosal sinus after two months with no complications. One bilateral cavernous sinus DAVF was embolized with Onyx via the inferior petrosal sinus by two operations, and transient abducens nerve palsy occurred after embolization.

CONCLUSIONSBecause Onyx may be injected via a transvenous approach and the microcatheter is easily withdrawn, cavernous sinus via transvenous catheterization and embolization is a safe and efficient way to treat complicated cavernous dural arteriovenous fistulas, especially those for which operations via transarterial approaches have failed, or spontaneous cavernous dural arteriovenous fistulas.

Adult ; Aged ; Arteriovenous Fistula ; complications ; therapy ; Cavernous Sinus ; abnormalities ; Dimethyl Sulfoxide ; administration & dosage ; Dura Mater ; blood supply ; Embolization, Therapeutic ; methods ; Female ; Humans ; Male ; Middle Aged ; Polyvinyls ; administration & dosage

OBJECTIVETo discuss the diagnosis, treatment and prognosis of spinal dural arteriovenous fistulas (SDAVF).

METHODSThe clinical and following-up date from 110 patients with SDAVF diagnosed by spinal MRI and spinal angiography were analyzed retrospectively.

RESULTSDraining vein between fistula and spinal cord was interrupted by laminectomy approach as first choice in 61 patients, by hemi-laminectomy approach in 37, and by endovascular embolization in 12, and re-operation due to recurrence after embolization in 3. Anticoagulation, hydration and early rehabilitation were used postoperatively. Complete disappearance of SDAVF was confirmed in all 106 patients who received postoperative spinal angiography. The para-medullary tortuous flow voids fully disappeared in 74 patients and partly disappeared in 15 on postoperative T(2)-weighted MRI. Follow up of 98 patients showed complete recovery in 54 patients, improvement in 34, and no change in 10. Three of the 10 patients were reoperated on because of recurrence 1 to 5 years after embolization.

CONCLUSIONSSDAVF can produce good outcome after early diagnosis and treatment. Interruption of the draining vein between fistula and spinal cord by hemi-laminectomy approach is the first choice for the treatment of SDAVF.

Adult ; Aged ; Central Nervous System Vascular Malformations ; diagnosis ; therapy ; Drainage ; Dura Mater ; blood supply ; Embolization, Therapeutic ; methods ; Female ; Humans ; Laminectomy ; methods ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord ; blood supply

Carotid cavernous dural arteriovenous fistula (DAVF) usually presents with conjunctival injection, proptosis, loss of visual acuity and ophthalmoplegia. There have been some carotid cavernous DAVF case reports presenting with isolated oculomotor, abducens and trochlear nerve palsy. We experienced a patient presenting with bilateral abducens nerve palsy and no other ocular signs who was diagnosed as carotid cavernous DAVF after conventional angiography. According to this case, carotid cavernous DAVF should be considered in the differential diagnosis of isolated bilateral abducens nerve palsy, in which case conventional angiography may be helpful in diagnosis.
Abducens Nerve/physiopathology* ; Arteriovenous Fistula/complications* ; Carotid Artery Diseases/complications* ; Case Report ; Cavernous Sinus*/radiography ; Cranial Nerve Diseases/physiopathology ; Cranial Nerve Diseases/etiology ; Dura Mater/blood supply* ; Female ; Human ; Middle Age ; Paralysis/physiopathology ; Paralysis/etiology*

Arteriovenous Fistula ; therapy ; Brain Ischemia ; therapy ; Carotid-Cavernous Sinus Fistula ; therapy ; Cerebrovascular Disorders ; therapy ; Dura Mater ; blood supply ; Embolization, Therapeutic ; methods ; Humans ; Intracranial Aneurysm ; therapy ; Intracranial Arteriovenous Malformations ; therapy ; Stents