[Endovascular treatment of pure spontaneous dural vascular malformations. Review of 23 cases studied and treated between May 1980 and October 1983].

The authors present 23 cases of pure dural spontaneous vascular malformations (DVM) between 1980 and 1983; among the 23 patients, presented with a sellar DVM, 10 with a torcular DVM and adjacent sinuses, 1 DVM was located at the lamina cribriformis. The history of the patients can be classified into 3 groups: - trauma history (9 patients); - vascular disease (15 patients); - infections history (1 patient). Certain remarkable associations were encountered: 2 cases of multifocal DVM, 3 cases with intracranial aneurysms, 1 case with a brain AVM in an other territory, 1 maxillo-facial AVM. Certain aspects of the symptomatology can be noted: 1 case was in a child of 3 years of age, 2 cases presented during pregnancy, 1 case with premenstrual changes, 2 cases with acute choroidal detachment. Of the 11 patients which had a DVM with cortical venous drainage, 9 were complaining of CNS symptoms and 3 were explored in emergency: 2 for SAH, 1 for acute spontaneous SDH. In this series, following a multidisciplinary decision, the treatment chosen was always endovascular a priori. However it was preceded in one case by surgery at the anterior base of the skull in order to develop a collateral circulation from a reachable artery (for embolization); in an other case, it was followed by surgery to evacuate a compressive SDH, and in an other it was completed by surgery to improve a too proximal embolization. Only once had the internal carotid artery to be occluded to obtain a satisfactory clinical result. One slowly regressive complication was noted following active heparin therapy. No patient has been excluded from this series during that period. With the exception of 1 spontaneous cure, following embolization (s) 13 cases are asymptomatic among which 9 have an anatomical "cure"; 4 cases have an incomplete but significant improvement; 1 patient after a initial good result had recurrent symptoms were stabilized with medical treatment; 2 cases were not embolized for technical reasons, but are asymptomatic. Finally, one died a few days after surgery for evacuation of his SDH. Details of embolic agents and vessels embolized are specified. 5 observations can be made: - The angiographic screening must be complete and must not overlook dangerous vessels which could limit the embolization. - All the vascular compartments of the lesion must be visualized, as all of them do not have to be embolized; the embolic agent has to be radio-opaque and the nidus of the malformation must be reached.(ABSTRACT TRUNCATED AT 400 WORDS)