D F Vollherbst1, C Ulfert1, U Neuberger1, C Herweh1, M Laible2, S Nagel2, M Bendszus1, M A Möhlenbruch3. 1. From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.). 2. Neurology (M.L., S.N.), Heidelberg University Hospital, Heidelberg, Germany. 3. From the Departments of Neuroradiology (D.F.V., C.U., U.N., C.H., M.B., M.A.M.) markus.moehlenbruch@med.uni-heidelberg.de.
Abstract
BACKGROUND AND PURPOSE: Sinus-preserving endovascular embolization was described as a promising treatment technique for dural arteriovenous fistulas. Our aim was to report our single-center experience in patients with dural arteriovenous fistulas who were treated with transarterial liquid embolization in combination with transvenous balloon-assisted protection of the affected venous sinus. MATERIALS AND METHODS: A retrospective analysis of a prospectively collected data base was performed. Demographic and clinical data, angiographic features of the dural arteriovenous fistulas, procedural parameters, complications, treatment success, follow-up imaging, and clinical outcome were assessed. RESULTS: Twenty-two patients were treated in 25 procedures. All patients were symptomatic, of whom 81.8% presented with tinnitus; 9.1%, with ocular symptoms; and 9.1%, with headache. Most fistulas were located at the transverse and/or sigmoid sinus. The most frequent fistula type was Cognard IIa+b (40.9%), followed by Cognard I (31.8%) and Cognard IIa (27.3%)/Borden I (59.1%), followed by Borden II (40.9%). The affected sinus could be preserved in all except for 1 patient in whom it was sacrificed in a second treatment procedure by coil embolization. The overall complete occlusion rate was 86.4%. The overall complication rate was 20%, with transient and permanent morbidity and mortality of 8%, 0%, and 0%, respectively. After a mean follow-up of 18 months, most patients (68.2%) achieved complete symptom remission, 27.3% showed symptom relief, and 4.6% had stable symptoms. CONCLUSIONS: Transarterial liquid embolization of dural arteriovenous fistulas in combination with transvenous balloon-assisted protection of the venous sinus is feasible and safe and offers high rates of occlusion and of symptom remission.
BACKGROUND AND PURPOSE: Sinus-preserving endovascular embolization was described as a promising treatment technique for dural arteriovenous fistulas. Our aim was to report our single-center experience in patients with dural arteriovenous fistulas who were treated with transarterial liquid embolization in combination with transvenous balloon-assisted protection of the affected venous sinus. MATERIALS AND METHODS: A retrospective analysis of a prospectively collected data base was performed. Demographic and clinical data, angiographic features of the dural arteriovenous fistulas, procedural parameters, complications, treatment success, follow-up imaging, and clinical outcome were assessed. RESULTS: Twenty-two patients were treated in 25 procedures. All patients were symptomatic, of whom 81.8% presented with tinnitus; 9.1%, with ocular symptoms; and 9.1%, with headache. Most fistulas were located at the transverse and/or sigmoid sinus. The most frequent fistula type was Cognard IIa+b (40.9%), followed by Cognard I (31.8%) and Cognard IIa (27.3%)/Borden I (59.1%), followed by Borden II (40.9%). The affected sinus could be preserved in all except for 1 patient in whom it was sacrificed in a second treatment procedure by coil embolization. The overall complete occlusion rate was 86.4%. The overall complication rate was 20%, with transient and permanent morbidity and mortality of 8%, 0%, and 0%, respectively. After a mean follow-up of 18 months, most patients (68.2%) achieved complete symptom remission, 27.3% showed symptom relief, and 4.6% had stable symptoms. CONCLUSIONS: Transarterial liquid embolization of dural arteriovenous fistulas in combination with transvenous balloon-assisted protection of the venous sinus is feasible and safe and offers high rates of occlusion and of symptom remission.
Authors: K D Bhatia; H Lee; H Kortman; J Klostranec; W Guest; T Wälchli; I Radovanovic; T Krings; V M Pereira Journal: AJNR Am J Neuroradiol Date: 2021-10-07 Impact factor: 3.825
Authors: K D Bhatia; H Lee; H Kortman; J Klostranec; W Guest; T Wälchli; I Radovanovic; T Krings; V M Pereira Journal: AJNR Am J Neuroradiol Date: 2021-10-14 Impact factor: 3.825
Authors: Alan Mendez-Ruiz; Waldo R Guerrero; Viktor Szeder; Mudassir Farooqui; Cynthia B Zevallos; Darko Quispe-Orozco; Santiago Ortega-Gutierrez Journal: Interv Neuroradiol Date: 2021-09-13 Impact factor: 1.764
Authors: J O Zamponi; F P Trivelato; M T S Rezende; R K Freitas; L H de Castro-Afonso; G S Nakiri; T G Abud; A C Ulhôa; D G Abud Journal: AJNR Am J Neuroradiol Date: 2020-10-01 Impact factor: 3.825
Authors: D F Vollherbst; C Herweh; S Schönenberger; F Seker; S Nagel; P A Ringleb; M Bendszus; M A Möhlenbruch Journal: AJNR Am J Neuroradiol Date: 2019-11-21 Impact factor: 3.825