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Gerasimenko A, Mignot C, Naggara O, Coulet F, Ekram S, Heide S, Sorato C, Mazowiecki M, Perrin L, Colas C, Cusin V, Caux F, Dardenne A, El Chehadeh S, Verloes A, Maurey H, Afenjar A, Petit F, Barete S, Boespflug-Tanguy O, Bourrat E, Capri Y, Ciorna V, Deb W, Doummar D, Perrier A, Guédon A, Houdart E, Isidor B, Jacquemont ML, Buffet C, Mercier S, Passemard S, Riquet A, Ruaud L, Schaefer E, Heron D, Bisdorff A, Benusiglio PR. Cerebral dural arteriovenous fistulas in patients with PTEN-related hamartoma tumor syndrome. Clin Genet 2024; 106:90-94. [PMID: 38424388 DOI: 10.1111/cge.14515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
Central nervous system (CNS) dural arteriovenous fistulas (DAVF) have been reported in PTEN-related hamartoma tumor syndrome (PHTS). However, PHTS-associated DAVF remain an underexplored field of the PHTS clinical landscape. Here, we studied cases with a PTEN pathogenic variant identified between 2007 and 2020 in our laboratory (n = 58), and for whom brain imaging was available. Two patients had DAVF (2/58, 3.4%), both presenting at advanced stages: a 34-year-old man with a left lateral sinus DAVF at immediate risk of hemorrhage, and a 21-year-old woman with acute intracranial hypertension due to a torcular DAVF. Interestingly, not all patients had 3D TOF/MRA, the optimal sequences to detect DAVF. Early diagnosis of DAVF can be lifesaving, and is easier to treat compared to developed, proliferative, or complex lesions. As a result, one should consider brain MRI with 3D TOF/MRA in PHTS patients at genetic diagnosis, with subsequent surveillance on a case-by-case basis.
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Affiliation(s)
- Anna Gerasimenko
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Hôpital la Pitié Salpêtrière, Paris, France
- APHP.Sorbonne Université, GH Pitié Salpêtrière et Trousseau, Service de Génétique, Centre de référence "déficiences intellectuelles de causes rares", Paris, France
| | - Cyril Mignot
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Hôpital la Pitié Salpêtrière, Paris, France
- APHP.Sorbonne Université, GH Pitié Salpêtrière et Trousseau, Service de Génétique, Centre de référence "déficiences intellectuelles de causes rares", Paris, France
| | - Olivier Naggara
- Université Paris Cité, INSERM UMR 1266 IMA-BRAIN, GHU Paris, Service de Neuroradiologie, Paris, France
- APHP.Université Paris Cité, Institut Imagine, INSERM U1000, Hôpital Necker - Enfants Malades, Service de Radiologie Pédiatrique UMR 1163, Paris, France
- APHP.Université Paris Cité, Centre Français pour les AVC Pédiatriques, INSERM U894, Paris, France
| | - Florence Coulet
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Paris, France
- Département de Génétique Médicale, APHP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Samar Ekram
- Department of Medical Genetics, College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| | - Solveig Heide
- APHP.Sorbonne Université, GH Pitié Salpêtrière et Trousseau, Service de Génétique, Centre de référence "déficiences intellectuelles de causes rares", Paris, France
| | - Clarisse Sorato
- APHP.Sorbonne Université, GH Pitié Salpêtrière et Trousseau, Service de Génétique, Centre de référence "déficiences intellectuelles de causes rares", Paris, France
| | - Maxime Mazowiecki
- APHP.Sorbonne Université, GH Pitié Salpêtrière et Trousseau, Service de Génétique, Centre de référence "déficiences intellectuelles de causes rares", Paris, France
| | - Laurence Perrin
- APHP.Université Paris Cité, Hôpital Robert-Debré, Service de Génétique, Paris, France
| | - Chrystelle Colas
- Université Paris Sciences Lettres, Institut Curie, Service de Génétique, Paris, France
| | - Veronica Cusin
- Département de Génétique Médicale, APHP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Frédéric Caux
- GH Paris Seine-Saint-Denis, INSERM UMR1125, Service de Dermatologie, Bobigny, France
| | - Antoine Dardenne
- APHP.Sorbonne Université, Hôpital Saint-Antoine, Oncologie Gigestive, Paris, France
| | - Salima El Chehadeh
- Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Institut de Génétique Médicale d'Alsace (IGMA), Service de Génétique Médicale, Strasbourg, France
| | - Alain Verloes
- APHP.Université Paris Cité, Hôpital Robert-Debré, Service de Génétique, Paris, France
- INSERM U1141, Hôpital Robert-Debré, Paris, France
| | - Hélène Maurey
- Hôpitaux Universitaires Paris Saclay, Hôpital Bicêtre, Centre National de Référence pour les Maladies Rares du Cerveau et de la Moelle Épinière, Service de Neurologie Pédiatrique, Le Kremlin Bicêtre, France
| | - Alexandra Afenjar
- Groupe d'Étude Interdisciplinaire pour les Malformations Vasculaires, Hôpitaux Lariboisière, Bichat, Saint-Joseph, Clinique Alma, Paris, France
| | - Florence Petit
- APHP.Sorbonne Université, GH Trousseau, Département de Génétique, Centre de référence "déficiences intellectuelles de causes rares", Paris, France
| | - Stéphane Barete
- Université de Lille, ULR7364 RADEME, CHU Lille, Clinique de Génétique, Guy Fontaine, Lille, France
| | - Odile Boespflug-Tanguy
- APHP.Sorbonne Université, GH Pitié-Salpêtrière, Service de Dermatologie, Paris, France
- APHP.Université Paris Cité, Hôpital Robert Debré, Service de Neuropédiatrie, Paris, France
| | | | - Yline Capri
- APHP.Université Paris Cité, Hôpital Robert-Debré, Service de Génétique, Paris, France
| | - Viorica Ciorna
- Hôpital-Saint Louis, CRMR MAGEC Nord St Louis, Service de Dermatologie, Paris, France
| | - Wallid Deb
- CHR Metz-Thionville, Service de Génétique, Metz, France
| | - Diane Doummar
- CHU Nantes, Service de Génétique Médicale, Nantes, France
| | - Alexandre Perrier
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Paris, France
- Département de Génétique Médicale, APHP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alexis Guédon
- APHP.Sorbonne Université, CHU Armand Trousseau, Service de Neuropédiatrie-Pathologie du développement, Centre de Référence Maladies Rares Neurogénétiques, Paris, France
| | - Emmanuel Houdart
- APHP.Sorbonne Université, CHU Armand Trousseau, Service de Neuropédiatrie-Pathologie du développement, Centre de Référence Maladies Rares Neurogénétiques, Paris, France
| | | | - Marie-Line Jacquemont
- APHP.Université Paris Cité, Service de Neuroradiologie Diagnostique et Interventionnelle, CHU Lariboisière, Paris, France
| | - Camille Buffet
- Service de Génétique Médicale, CHU Ste-Justine, Montréal, Canada
| | | | - Sandrine Passemard
- APHP.Sorbonne Université, Service de pathologies Thyroïdiennes et Tumorales Endocrines, Hôpital La Pitié-Salpêtrière, Paris, France
| | - Audrey Riquet
- APHP.Université Paris Cité, Inserm UMR 1141, NeuroDiderotFrance, Hôpital Robert Debré, Service de Neurologie Pédiatrique, DMU INOV-RDB, Paris, France
| | - Lyse Ruaud
- APHP.Université Paris Cité, Hôpital Robert-Debré, Service de Génétique, Paris, France
- INSERM U1141, Hôpital Robert-Debré, Paris, France
| | - Elise Schaefer
- Département de Neurologie Pédiatrique, GHICL, Hôpital Saint Vincent de Paul, Lille, France
| | - Delphine Heron
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Hôpital la Pitié Salpêtrière, Paris, France
- APHP.Sorbonne Université, GH Pitié Salpêtrière et Trousseau, Service de Génétique, Centre de référence "déficiences intellectuelles de causes rares", Paris, France
| | - Annouk Bisdorff
- APHP.Sorbonne Université, CHU Armand Trousseau, Service de Neuropédiatrie-Pathologie du développement, Centre de Référence Maladies Rares Neurogénétiques, Paris, France
- CHU de Strasbourg, Service de Génétique Médicale, IGMA, Strasbourg, France
| | - Patrick R Benusiglio
- Sorbonne Université, INSERM, Unité Mixte de Recherche Scientifique 938 et SIRIC CURAMUS, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Paris, France
- Département de Génétique Médicale, APHP.Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
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2
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Rossmann T, Veldeman M, Oulasvirta E, Nurminen V, Rauch P, Gruber A, Lehecka M, Niemelä M, Numminen J, Raj R. Long-term risk of hemorrhage and mortality after treatment of high-grade intracranial dural arteriovenous fistulas. J Neurointerv Surg 2024:jnis-2024-021688. [PMID: 38839281 DOI: 10.1136/jnis-2024-021688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/18/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Despite recent multi-institutional efforts, long-term data on clinical and radiological outcomes after treatment of high-grade dural arteriovenous fistulas (dAVFs) remain scarce. This study aimed to evaluate the long-term risk of hemorrhage and fistula-related mortality after treatment. METHODS Retrospective analysis of all consecutive patients primarily diagnosed with a high-grade dAVF (Cognard grade 2b, 2a+b, 3, 4) between January 2012 and September 2022 at a large neurovascular center. Primary endpoints were intracranial hemorrhage (ICH) and all-cause mortality after treatment; secondary endpoints were angiographic occlusion, complication rate and neurological deficits. RESULTS A total of 121 patients underwent 141 treatments (122 endovascular therapy (EVT), 5 radiotherapy, 14 surgery) of which 12 patients (10%) underwent retreatment. Follow-up was available in all patients for a median of 4.2 (IQR 2.5 to 6.6) years. Eleven patients (9%) died during the follow-up period, of which three deaths (2%) occurred after hemorrhagic presentation, one of them attributable to treatment. One death (0.8%) was due to delayed hemorrhage after partial occlusion from EVT. No other post-treatment bleedings occurred. Angiographic follow-up after multimodality treatment was available in 93% of patients after a median of 6 months; the overall occlusion rate was 90%. The overall rate of complications was 25% after EVT and 14% after surgery. The rates of new transient and permanent neurological deficits after EVT were 9% and 3%, respectively. CONCLUSIONS The long-term rate of re-bleeding or dAVF-related mortality was low when high rates of angiographic occlusion were achieved. The risk for treatment-related complications leading to neurological sequela was low.
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Affiliation(s)
- Tobias Rossmann
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Michael Veldeman
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
- Department of Neurosurgery, Universitätsklinikum Aachen, Aachen, Germany
| | - Elias Oulasvirta
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Ville Nurminen
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Philip Rauch
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Jussi Numminen
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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Kropp AE, Nishihori M, Izumi T, Goto S, Yokoyama K, Saito R. Hormone Concentration Measurement in Intracranial Dural Arteriovenous Fistulae. World Neurosurg 2024; 185:e451-e460. [PMID: 38367858 DOI: 10.1016/j.wneu.2024.02.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Intracranial dural arteriovenous fistulae (DAVFs) represent a subset of cerebral vascular malformations associated with significant morbidity and mortality. In Japan, DAVF exhibits sex-based differences in anatomical distribution, with female predominance in the cavernous sinus (CS) and male predominance in the transverse sinus (TS). Nevertheless, the pathophysiology of DAVF is not fully understood, and hormonal influences are hypothesized to play a role in its development. This study aimed to investigate changes in the concentrations of sex steroid hormones between intracranial and peripheral sampling sites in patients with CS- and TS-DAVF. METHODS We recruited 19 patients with CS-DAVF (n = 12) and TS-DAVF (n = 7) in this study. Blood hormone measurements were obtained from peripheral and jugular bulb samples during endovascular intervention. Hormone concentrations were analyzed using enzyme-linked immunosorbent assay kits, and statistical analyses were performed. RESULTS Our study revealed a higher prevalence of CS-DAVF in females and TS-DAVF in males, which is consistent with previous studies. Estradiol concentration was significantly lower in the jugular bulb compared with in the periphery in both patients with CS- and TS-DAVF. This decrease in estradiol was observed irrespective of the patient's sex and independent of follicle-stimulating hormone levels. CONCLUSIONS These findings indicate a local decrease in estradiol levels within the intracranial vasculature of patients with DAVF. This suggests a potential multifactorial role of estradiol in the pathomechanism of DAVFs, warranting further investigation to understand its influence on DAVF formation and potential targeted therapies, thereby enhancing patient outcomes.
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Affiliation(s)
- Asuka Elisabeth Kropp
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Showa-ku, Nagoya Aichi, Japan
| | - Masahiro Nishihori
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Showa-ku, Nagoya Aichi, Japan.
| | - Takashi Izumi
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Showa-ku, Nagoya Aichi, Japan
| | - Shunsaku Goto
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Showa-ku, Nagoya Aichi, Japan
| | - Kinya Yokoyama
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Showa-ku, Nagoya Aichi, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University of Graduate School of Medicine, Showa-ku, Nagoya Aichi, Japan
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4
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Becerril-Gaitan A, Ding D, Ironside N, Buell TJ, Kansagra AP, Lanzino G, Brinjikji W, Kim L, Levitt MR, Abecassis IJ, Bulters D, Durnford A, Fox WC, Blackburn S, Chen PR, Polifka AJ, Laurent D, Gross B, Hayakawa M, Derdeyn C, Amin-Hanjani S, Alaraj A, van Dijk JMC, Potgieser ARE, Starke RM, Peterson EC, Satomi J, Tada Y, Abla AA, Winkler EA, Du R, Lai PMR, Zipfel GJ, Chen CJ, Sheehan JP. The VEBAS score: a practical scoring system for intracranial dural arteriovenous fistula obliteration. J Neurointerv Surg 2024; 16:272-279. [PMID: 37130751 DOI: 10.1136/jnis-2023-020282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Tools predicting intracranial dural arteriovenous fistulas (dAVFs) treatment outcomes remain scarce. This study aimed to use a multicenter database comprising more than 1000 dAVFs to develop a practical scoring system that predicts treatment outcomes. METHODS Patients with angiographically confirmed dAVFs who underwent treatment within the Consortium for Dural Arteriovenous Fistula Outcomes Research-participating institutions were retrospectively reviewed. A subset comprising 80% of patients was randomly selected as training dataset, and the remaining 20% was used for validation. Univariable predictors of complete dAVF obliteration were entered into a stepwise multivariable regression model. The components of the proposed score (VEBAS) were weighted based on their ORs. Model performance was assessed using receiver operating curves (ROC) and areas under the ROC. RESULTS A total of 880 dAVF patients were included. Venous stenosis (presence vs absence), elderly age (<75 vs ≥75 years), Borden classification (I vs II-III), arterial feeders (single vs multiple), and past cranial surgery (presence vs absence) were independent predictors of obliteration and used to derive the VEBAS score. A significant increase in the likelihood of complete obliteration (OR=1.37 (1.27-1.48)) with each additional point in the overall patient score (range 0-12) was demonstrated. Within the validation dataset, the predicted probability of complete dAVF obliteration increased from 0% with a 0-3 score to 72-89% for patients scoring ≥8. CONCLUSION The VEBAS score is a practical grading system that can guide patient counseling when considering dAVF intervention by predicting the likelihood of treatment success, with higher scores portending a greater likelihood of complete obliteration.
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Affiliation(s)
- Andrea Becerril-Gaitan
- Neurosurgery Department, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Dale Ding
- Neurosurgery Department, University of Louisville, Louisville, Kentucky, USA
| | - Natasha Ironside
- Neurosurgery Department, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Thomas J Buell
- Neurosurgery Department, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Akash P Kansagra
- Neurosurgery Department, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | - Louis Kim
- Neurosurgery Department, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Neurosurgery Department, University of Washington, Seattle, Washington, USA
| | | | - Diederik Bulters
- Neurosurgery Department, University of Southampton, Southampton, UK
| | - Andrew Durnford
- Neurosurgery Department, University of Southampton, Southampton, UK
| | - W Christopher Fox
- Neurosurgery Department, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
| | - Spiros Blackburn
- Neurosurgery Department, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Peng Roc Chen
- Neurosurgery Department, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Adam J Polifka
- Neurosurgery Department, University of Florida, Gainesville, Florida, USA
| | - Dimitri Laurent
- Neurosurgery Department, University of Florida, Gainesville, Florida, USA
| | - Bradley Gross
- Neurosurgery Department, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Minako Hayakawa
- Radiology and Interventional Radiology Department, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Colin Derdeyn
- Radiology and Interventional Radiology Department, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Sepideh Amin-Hanjani
- Neurosurgery Department, University Hospitals/Case Western Reserve University, Cleveland, Ohio, USA
| | - Ali Alaraj
- Neurosurgery Department, University of Illinois Chicago, Chicago, Illinois, USA
| | - J Marc C van Dijk
- Neurosurgery Department, University of Groningen, Groningen, The Netherlands
| | | | - Robert M Starke
- Neurosurgery Department, University of Miami Miller School of Medicine, Miami, Florida, USA
- Radiology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eric C Peterson
- Neurosurgery Department, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Junichiro Satomi
- Neurosurgery Department, University of Tokushima, Tokushima, Japan
| | - Yoshiteru Tada
- Neurosurgery Department, University of Tokushima, Tokushima, Japan
| | - Adib A Abla
- Neurosurgery Department, University of California San Francisco, San Francisco, California, USA
| | - Ethan A Winkler
- Neurosurgery Department, University of California San Francisco, San Francisco, California, USA
| | - Rose Du
- Neurosurgery Department, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pui Man Rosalind Lai
- Neurosurgery Department, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gregory J Zipfel
- Neurosurgery Department, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ching-Jen Chen
- Neurosurgery Department, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jason P Sheehan
- Neurosurgery Department, University of Virginia Health System, Charlottesville, Virginia, USA
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Zhang G, Zhang W, Chang H, Shen Y, Ma C, Mao L, Li Z, Lu H. Endovascular treatment strategy and clinical outcome of tentorial dural arteriovenous fistula. Front Neurol 2024; 14:1315813. [PMID: 38371305 PMCID: PMC10870646 DOI: 10.3389/fneur.2023.1315813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Introduction To evaluate treatment strategies and clinical outcomes following endovascular embolization of tentorial dural arteriovenous fistulas. Methods We retrospectively analyzed 19 patients with tentorial dural arteriovenous fistulas admitted to the Department of Neurosurgery at Jiangsu Provincial People's Hospital between October 2015 and May 2022, all treated with endovascular therapy. To collect and analyze patients' clinical presentation, imaging data, postoperative complications, and prognosis and to analyze the safety and clinical outcomes of endovascular treatment of tentorial dural arteriovenous fistulas. Results Imaging cure was achieved in 18 patients, with the arterial route chosen for embolization in 17 patients and the venous route in one patient; one patient received partial embolization. Staged embolization was performed in four patients. At postoperative follow-up of 9-83 months (37.8 ± 21.2), all 19 patients had recovered well (mRS score ≤ 2). Three patients experienced perioperative complications: intraoperative Onyx reflux into the middle cerebral artery in one patient; postoperative permanent limited left visual field loss and deafness in the left ear in one patient; and transient diplopia, vertigo, and decreased pain and temperature sensation of the left limb in one patient, with no abnormalities on post-procedure magnetic resonance examinations. A total of 17 patients completed a postoperative digital subtraction angiography review during follow-up, and one patient had a recurrence of an arteriovenous fistula. Conclusion Endovascular treatment of tentorial dural arteriovenous fistulas is safe and effective. Reduction of the Borden or Cognard classification via eliminating cortical venous reflux through multi-staged embolization or combined open surgery is a reasonable goal of treatment where complete obliteration of the fistula is not achievable.
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Affiliation(s)
- Guangjian Zhang
- Department of Emergency, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Weiwei Zhang
- Department of Ophthalmology, Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hanxiao Chang
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuqi Shen
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chencheng Ma
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lei Mao
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zheng Li
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hua Lu
- Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China
- Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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6
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Sanchez S, Raghuram A, Wendt L, Hayakawa M, Chen CJ, Sheehan JP, Kim LJ, Abecassis IJ, Levitt MR, Meyer RM, Guniganti R, Kansagra AP, Lanzino G, Giordan E, Brinjikji W, Bulters DO, Durnford A, Fox WC, Smith J, Polifka AJ, Gross B, Amin-Hanjani S, Alaraj A, Kwasnicki A, Starke RM, Chen SH, van Dijk JMC, Potgieser ARE, Satomi J, Tada Y, Phelps R, Abla A, Winkler E, Du R, Lai PMR, Zipfel GJ, Derdeyn C, Samaniego EA. Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas. J Neurointerv Surg 2023; 15:903-908. [PMID: 35944975 DOI: 10.1136/jnis-2022-019160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anterior cranial fossa dural arteriovenous fistulas (ACF-dAVFs) are aggressive vascular lesions. The pattern of venous drainage is the most important determinant of symptoms. Due to the absence of a venous sinus in the anterior cranial fossa, most ACF-dAVFs have some degree of drainage through small cortical veins. We describe the natural history, angiographic presentation and outcomes of the largest cohort of ACF-dAVFs. METHODS The CONDOR consortium includes data from 12 international centers. Patients included in the study were diagnosed with an arteriovenous fistula between 1990-2017. ACF-dAVFs were selected from a cohort of 1077 arteriovenous fistulas. The presentation, angioarchitecture and treatment outcomes of ACF-dAVF were extracted and analyzed. RESULTS 60 ACF-dAVFs were included in the analysis. Most ACF-dAVFs were symptomatic (38/60, 63%). The most common symptomatic presentation was intracranial hemorrhage (22/38, 57%). Most ACF-dAVFs drained through cortical veins (85%, 51/60), which in most instances drained into the superior sagittal sinus (63%, 32/51). The presence of cortical venous drainage predicted symptomatic presentation (OR 9.4, CI 1.98 to 69.1, p=0.01). Microsurgery was the most effective modality of treatment. 56% (19/34) of symptomatic patients who were treated had complete resolution of symptoms. Improvement of symptoms was not observed in untreated symptomatic ACF-dAVFs. CONCLUSION Most ACF-dAVFs have a symptomatic presentation. Drainage through cortical veins is a key angiographic feature of ACF-dAVFs that accounts for their malignant course. Microsurgery is the most effective treatment. Due to the high risk of bleeding, closure of ACF-dAVFs is indicated regardless of presentation.
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Affiliation(s)
- Sebastian Sanchez
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Ashrita Raghuram
- Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Linder Wendt
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, USA
| | - Minako Hayakawa
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jason P Sheehan
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Louis J Kim
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | | | - Michael R Levitt
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - R Michael Meyer
- Department of Neurosurgery, University of Washington, Seattle, Washington, USA
| | - Ridhima Guniganti
- Department of Neurosurgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Akash P Kansagra
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Giuseppe Lanzino
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Enrico Giordan
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Diederik O Bulters
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
| | - Andrew Durnford
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
| | - W Christopher Fox
- Department of Neurosurgery, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA
| | - Jessica Smith
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Adam J Polifka
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Bradley Gross
- Department of Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Amanda Kwasnicki
- Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA
| | - Robert M Starke
- Department of Neurosurgery, University of Miami, Coral Gables, Florida, USA
| | - Stephanie H Chen
- Department of Neurosurgery, University of Miami, Coral Gables, Florida, USA
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, Groningen, Groningen, Netherlands
| | - Adriaan R E Potgieser
- Department of Neurosurgery, University of Groningen, Groningen, Groningen, Netherlands
| | - Junichiro Satomi
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan
| | - Yoshiteru Tada
- Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan
| | - Ryan Phelps
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Adib Abla
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Ethan Winkler
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Pui Man Rosalind Lai
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gregory J Zipfel
- Department of Neurosurgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Colin Derdeyn
- Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Edgar A Samaniego
- Departments of Neurology, Radiology and Neurosurgery, The University of Iowa, Iowa City, Iowa, USA
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7
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Lauzier DC, Moran CJ. Lessons from the Past: Finding the True Prevalence of Dural Arteriovenous Fistulae. World Neurosurg 2023; 175:158. [PMID: 37105894 DOI: 10.1016/j.wneu.2023.03.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- David C Lauzier
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Christopher J Moran
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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8
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Tu T, Peng Z, Song Z, Ma Y, Zhang H. New insight into DAVF pathology—Clues from meningeal immunity. Front Immunol 2022; 13:858924. [PMID: 36189220 PMCID: PMC9520480 DOI: 10.3389/fimmu.2022.858924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022] Open
Abstract
In recent years, with the current access in techniques, studies have significantly advanced the knowledge on meningeal immunity, revealing that the central nervous system (CNS) border acts as an immune landscape. The latest concept of meningeal immune system is a tertiary structure, which is a comprehensive overview of the meningeal immune system from macro to micro. We comprehensively reviewed recent advances in meningeal immunity, particularly the new understanding of the dural sinus and meningeal lymphatics. Moreover, based on the clues from the meningeal immunity, new insights were proposed into the dural arteriovenous fistula (DAVF) pathology, aiming to provide novel ideas for DAVF understanding.
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Affiliation(s)
- Tianqi Tu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhenghong Peng
- Department of Health Management Center, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zihao Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yongjie Ma, ; Hongqi Zhang,
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- International Neuroscience Institute (China-INI), Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yongjie Ma, ; Hongqi Zhang,
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9
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Yamaguchi I, Kanematsu Y, Shimada K, Yamamoto N, Miyake K, Miyamoto T, Sogabe S, Shikata E, Ishihara M, Yamamoto Y, Kuroda K, Takagi Y. Single-session hematoma removal and transcortical venous approach for coil embolization of an isolated transverse-sigmoid sinus dural arteriovenous fistula in a hybrid operating room: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 3:CASE2267. [PMID: 35734231 PMCID: PMC9204917 DOI: 10.3171/case2267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Dural arteriovenous fistula (DAVF) can present with massive hematoma, which sometimes requires emergent removal. Therefore, a surgical strategy for single-session hematoma removal and shunt occlusion in the same surgical field is important. OBSERVATIONS A 73-year-old man was transferred to the authors' hospital with a headache. Brain computed tomography (CT) revealed an intracerebral hematoma in the right temporoparietal lobe (hematoma volume 12 ml). A cerebral angiogram revealed a right isolated transverse-sigmoid sinus (TSS)-DAVF fed by the occipital artery and middle meningeal artery. There was cortical venous reflux into the Labbé vein and posterior parietal vein. Percutaneous transarterial and transvenous embolization were unsuccessful. The following day, his consciousness level acutely declined with a headache, and brain CT showed hematoma expansion (hematoma volume 41 ml) with a midline shift. Therefore, the authors performed single-session hematoma removal and a transcortical venous approach for coil embolization of an isolated TSS-DAVF in a hybrid operating room. His postoperative course was uneventful. No recurrence was observed 3 months postoperatively on cerebral angiography. LESSONS Single-session hematoma removal and a transcortical venous approach for coil embolization of an isolated TSS-DAVF is considered in cases with massive hematoma. This strategy is useful, considering recent developments in hybrid operating rooms.
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Affiliation(s)
| | | | | | - Nobuaki Yamamoto
- Neurology, and
- Advanced Brain Research, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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