Nicola Limbucci1, Giuseppe Leone2, Sergio Nappini3, Andrea Rosi3, Leonardo Renieri3, Arturo Consoli3, Alessandro Pedicelli4, Salvatore Mangiafico3. 1. Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy. Electronic address: nicolalimb@gmail.com. 2. Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy; Department of Applied Biomedical Sciences, Federico II University of Naples, Naples, Italy. 3. Neurovascular Interventional Unit, Careggi University Hospital, Florence, Italy. 4. Institute of Radiological Sciences, Catholic University of Sacred Heart, Agostino Gemelli University Hospital, Rome, Italy.
Abstract
BACKGROUND: Ethmoidal dural arteriovenous fistulas (DAVFs) are rare and aggressive lesions, usually treated by microsurgical disconnection of the fistula. Transarterial embolization rarely is performed because of the risk of retinal ischemia. Transvenous embolization has been reported as an alternative approach. We describe our experience in transvenous embolization of ethmoidal DAVFs and review the literature focusing on technical and safety aspects of the procedure. METHODS: We retrospectively identified 4 patients with ethmoidal DAVFs treated by transvenous embolization in a single center. Clinical data and angiographic images were reviewed. We reviewed the literature after PubMed searching for articles describing patients treated by a transvenous approach. RESULTS: One patient was treated by transvenous coiling and 3 patients by retrograde Onyx injection through a detachable-tip microcatheter. Three fistulas drained in an ascending cortical frontal vein and one drained posteriorly in the olfactory vein. In all patients the fistula was occluded, in one case an asymptomatic hemorrhage occurred. In the literature 12 further cases of transvenous embolization of ethmoidal DAVFs have been reported. CONCLUSIONS: Transvenous embolization is an effective approach for the treatment of ethmoidal DAVFs in properly selected patients. Onyx injection through detachable-tip microcatheters increases the feasibility of the intervention.
BACKGROUND:Ethmoidal dural arteriovenous fistulas (DAVFs) are rare and aggressive lesions, usually treated by microsurgical disconnection of the fistula. Transarterial embolization rarely is performed because of the risk of retinal ischemia. Transvenous embolization has been reported as an alternative approach. We describe our experience in transvenous embolization of ethmoidal DAVFs and review the literature focusing on technical and safety aspects of the procedure. METHODS: We retrospectively identified 4 patients with ethmoidal DAVFs treated by transvenous embolization in a single center. Clinical data and angiographic images were reviewed. We reviewed the literature after PubMed searching for articles describing patients treated by a transvenous approach. RESULTS: One patient was treated by transvenous coiling and 3 patients by retrograde Onyx injection through a detachable-tip microcatheter. Three fistulas drained in an ascending cortical frontal vein and one drained posteriorly in the olfactory vein. In all patients the fistula was occluded, in one case an asymptomatic hemorrhage occurred. In the literature 12 further cases of transvenous embolization of ethmoidal DAVFs have been reported. CONCLUSIONS: Transvenous embolization is an effective approach for the treatment of ethmoidal DAVFs in properly selected patients. Onyx injection through detachable-tip microcatheters increases the feasibility of the intervention.
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