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Pandey A, Schreiber C, Garton ALA, Jung B, Goldberg JL, Kocharian G, Carnevale JA, Boddu SR. Future Directions and Innovations in Venous Sinus Stenting. World Neurosurg 2024; 184:387-394. [PMID: 38590072 DOI: 10.1016/j.wneu.2023.12.128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 04/10/2024]
Abstract
This review explores the future role of venous sinus stenting (VSS) in the management of idiopathic intracranial hypertension and pulsatile tinnitus. Despite its favorable safety profile and clinical outcomes compared with traditional treatments, VSS is not yet the standard of care for these conditions, lacking high-level evidence data and guidelines for patient selection and indications. Current and recently completed clinical trials are expected to provide data to support the adoption of VSS as a primary treatment option. Additionally, VSS shows potential in treating other conditions, such as dural arteriovenous fistula and cerebral venous sinus thrombosis, and it is likely that the procedure will continue to see an expansion of its approved indications. The current lack of dedicated venous stenting technology is being addressed with promising advancements, which may improve procedural ease and patient outcomes. VSS also offers potential for expansion into modulation of brain electrophysiology via endovascular routes, offering exciting possibilities for neurodiagnostics and treatment of neurodegenerative disorders.
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Affiliation(s)
- Abhinav Pandey
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Craig Schreiber
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Andrew L A Garton
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Brandon Jung
- Human Health Major (BA), Emory University, Atlanta, Georgia, USA
| | - Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Gary Kocharian
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Joseph A Carnevale
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Srikanth R Boddu
- Department of Neurological Surgery, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA.
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Pichardo-Rojas PS, Marín-Castañeda LA, De Nigris Vasconcellos F, Flores-López SI, Coria-Medrano A, de Teresa López-Zepeda P, Sánchez-Serrano CD, Torres-Chávez MC, Escobar-López JM, Choque-Ayala LC, Jowah G, Rangel-Castilla L. Simultaneous Parkinsonism and Dementia as Initial Presentation of Intracranial Dural Arteriovenous Fistulas: A Systematic Review. World Neurosurg 2024; 184:e554-e576. [PMID: 38336210 DOI: 10.1016/j.wneu.2024.01.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Intracranial dural arteriovenous fistulas (IDAVFs) are abnormal vascular connections between dural arteries and various venous structures within the brain. IDAVFs, rarely present with parkinsonism and dementia concurrently, making this a unique and underexplored clinical scenario. To the best of our knowledge, this is the first systematic review to comprehensively analyze cases of IDAVFs manifesting as both parkinsonism and dementia. METHODS We assessed databases from inception to September 18, 2023. We identified studies describing patients with IDAVFs initially presenting with dementia or parkinsonism. Inclusion criteria encompassed case reports and case series, while excluding review articles, guidelines, technical notes, comments, conference abstracts, and editorials. RESULTS The systematic search resulted in the initial screening of 383 studies, with 33 articles meeting the inclusion criteria. Among these, 29 were case reports, often describing 3 or fewer patients. From the remaining 4 case series, data pertinent to patients presenting both parkinsonism and dementia were selectively extracted, yielding a total study population of 43 patients. The anatomical distribution of IDAVFs within this cohort was diverse, with the transverse and sigmoid sinuses being the most common locations. Although most of these patients received endovascular therapy, a few underwent microsurgical occlusion or combined surgical and endovascular treatment. CONCLUSIONS IDAVFs presenting with both parkinsonism and dementia represent a rare clinical entity. This systematic review provides valuable insights into the clinical characteristics, treatment options, and outcomes for such cases. However, additional research involving larger cohorts is essential to better comprehend the underlying mechanisms and establish standardized therapeutic guidelines.
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Affiliation(s)
- Pavel S Pichardo-Rojas
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA.
| | | | - Fernando De Nigris Vasconcellos
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
| | - Shadia I Flores-López
- Centro de Investigación en Ciencias de la Salud (CICSA), Facultad en Ciencias de la Salud, Universidad Anáhuac México Campus Norte, Estado de México, Huixquilucan de Degollado, México
| | - Adrian Coria-Medrano
- Instituto de Neurobiología, Campus Universidad Nacional Autónoma de México-Juriquilla, Querétaro, México
| | | | - Claudia D Sánchez-Serrano
- Centro Universitario de Ciencias de la Salud, Guadalajara, Universidad de Guadalajara, Guadalajara, Jalisco, México
| | - Mario C Torres-Chávez
- Facultad de Medicina, Universidad Autónoma de Baja California, Mexicali, Baja California, México
| | - Jesús M Escobar-López
- Escuela de Ciencias de la Salud, Universidad Del Valle de México, Ciudad de México, México
| | - Luz C Choque-Ayala
- Facultad de Medicina, Universidad Católica Boliviana San Pablo, Santa Cruz de la Sierra, Bolivia
| | - Gorbachev Jowah
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, Texas, USA
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Kang N, Wang F, Xue Y, Wei H. Transverse-Sigmoid Sinus Dural Arteriovenous Fistula Concurrent With Bilateral Venous Sinus Occlusion. J Craniofac Surg 2023; 35:00001665-990000000-01110. [PMID: 37800968 PMCID: PMC11045404 DOI: 10.1097/scs.0000000000009764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/26/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND AND SIGNIFICANCE Dural arteriovenous fistula (DAVF) is a relatively rare type of cerebrovascular malformation with unknown pathogenesis. Here, the authors report a patient with DAVF in the left transverse-sigmoid sinus (Cognard type III) combined with occlusions of the left sigmoid sinus and right transverse sinus. The authors describe and discuss their successful treatment approach, with the aim to improve the management of this rare disorder. CASE PRESENTATION A 59-year-old man presented with dizziness, headache, vomiting, and unsteady gait. His digital subtraction angiography evaluation indicated DAVF in the left transverse-sigmoid sinus (Cognard type III) combined with occlusions of the distal 1/3 of the left sigmoid sinus and the proximal one-third of the right transverse sinus. After balloon angioplasty and stenting, blood flow was restored in the occluded sinuses. The DAVF was treated by embolization. The patient had a satisfactory recovery with significantly improved clinical symptoms. CONCLUSION In patients with transverse-sigmoid sinus DAVF, satisfactory venous reflux should be ensured. In patients with concurrent DAVF and sinus stenosis or occlusion, it is important to reestablish antegrade venous blood flow first. It is feasible and safe to simultaneously embolize DAVF after the venous reflux can be reestablished.
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Affiliation(s)
- Ningyu Kang
- Affiliated Hospital of Weifang Medical University
| | - Fei Wang
- Affiliated Hospital of Weifang Medical University
| | - Yan Xue
- Weifang Municipal Government Hospital, Weifang, China
| | - Haijian Wei
- Affiliated Hospital of Weifang Medical University
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Su X, Song Z, Tu T, Fan Y, Meng X, Gao Q, Ma Y, Zhang P, Zhang H. A retrospective study of 78 adult tentorial middle line region dural arteriovenous fistulae. Acta Neurol Belg 2023:10.1007/s13760-023-02237-7. [PMID: 36977967 DOI: 10.1007/s13760-023-02237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE Dural arteriovenous fistulae (DAVF) in the tentorial middle line region are uncommon with specific features and more cognitive disorders than any other region. The purpose of this study is to present clinical characteristics and our experience with endovascular treatment in this specific region. METHODS During a 20-year period, 94.9% of patients (74/78) underwent endovascular treatment (36 in galenic, 48.6%) (12 in straight sinus, 16.2%) (26 in torcular, 35.1%). There were 63 males and 15 females with mean age of 50 (50 ± 12) years in total of 78 patients. The clinical presentation, angiographic features, treatment strategy, and clinical outcomes were recorded. RESULTS Transarterial embolization (TAE) was performed in 89.2% of the 74 patients (66/74), transvenous embolization alone in one patient and mixed approach in seven. Complete obliteration of the fistulas was obtained in 87.5% of the patients (64/74). 71 patients (mean, 56 months) had phone, outpatient, or admission follow-up. The digital subtraction angiography (DSA) follow-up period (25/78, 32.1%) was 13.8 (6-21) months. Two of them (2/25, 8%) had fistula recurrences after complete embolization and were embolized again. The phone follow-up period (70/78, 89.7%) was 76.6 (40-92.3) months. Pre-embolization and post-embolization mRS ≥ 2 were in 44 patients (44/78) and 15 (15/71) patients, respectively. DAVF with internal cerebral vein drainage (OR 6.514, 95% Cl 1.201-35.317) and intracranial hemorrhage (OR 17.034, 95% Cl 1.122-258.612) during TAE were the risk factors for predicting poor outcomes (followed up mRS ≥ 2). CONCLUSIONS TAE is the first-line treatment for tentorial middle line region DAVF. When pial feeders' obliteration is difficult to achieve, it should not be forced due to the poor outcomes after intracranial hemorrhage. The cognitive disorders caused by this region were not reversible as reported. It is imperative to enhance the care provided to these patients with cognitive disorders.
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Affiliation(s)
- Xin Su
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China
| | - Zihao Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China
| | - Tianqi Tu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China
| | - Yuxiang Fan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China
| | - Xiaosheng Meng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China
| | - Qingling Gao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China.
| | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China.
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China.
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Osuki T, Ikeda H, Hayashi T, Park S, Uezato M, Kinosada M, Kurosaki Y, Handa A, Chin M. Gradual dilatation of an occluded transverse sinus associated with dural arteriovenous fistula after balloon angioplasty with sinus packing: A case report. Neuroradiol J 2021; 35:388-395. [PMID: 34423659 DOI: 10.1177/19714009211041529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is no consensus as to whether balloon angioplasty alone or stent placement is effective for sinus occlusion associated with dural arteriovenous fistula (DAVF). Herein, we first report a case of transverse sinus occlusion associated with DAVF in which gradual sinus dilatation was observed after balloon angioplasty with embolization of the affected sinus with shunt flow. CASE PRESENTATION A 69-year-old man presented with executive dysfunction. Magnetic resonance imaging revealed left transverse sinus-sigmoid sinus DAVF with occlusion of the left jugular vein and right transverse sinus. Before endovascular treatment, the patient had symptomatic epilepsy and subarachnoid hemorrhage. Retrograde leptomeningeal venous drainage disappeared with packing of the left transverse sinus-sigmoid sinus. Subsequently, balloon angioplasty of the right occluded transverse sinus was performed to maintain the normal venous drainage and remaining shunt outflow. Dilatation of the right transverse sinus was poor immediately after surgery. However, angiography after 10 days and 6 months revealed gradual dilatation of the right transverse sinus. CONCLUSION Sinus occlusion, which is thought to be caused by sinus hypertension associated with DAVF rather than chronic organized thrombosis or thrombophilia, may dilate over time after balloon angioplasty and shunt flow reduction if occluded sinus is necessary for facilitating normal venous drainage.
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Affiliation(s)
- Takuya Osuki
- Department of Neurosurgery, 13612Kurashiki Central Hospital, Kurashiki Central Hospital, Japan
| | - Hiroyuki Ikeda
- Department of Neurosurgery, 13612Kurashiki Central Hospital, Kurashiki Central Hospital, Japan
| | - Tomoko Hayashi
- Department of Neurosurgery, 13612Kurashiki Central Hospital, Kurashiki Central Hospital, Japan
| | - Silsu Park
- Department of Neurosurgery, 13612Kurashiki Central Hospital, Kurashiki Central Hospital, Japan
| | - Minami Uezato
- Department of Neurosurgery, 13612Kurashiki Central Hospital, Kurashiki Central Hospital, Japan
| | - Masanori Kinosada
- Department of Neurosurgery, 13612Kurashiki Central Hospital, Kurashiki Central Hospital, Japan
| | - Yoshitaka Kurosaki
- Department of Neurosurgery, 13612Kurashiki Central Hospital, Kurashiki Central Hospital, Japan
| | - Akira Handa
- Department of Neurosurgery, 13612Kurashiki Central Hospital, Kurashiki Central Hospital, Japan
| | - Masaki Chin
- Department of Neurosurgery, 13612Kurashiki Central Hospital, Kurashiki Central Hospital, Japan
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Lin YH, Lee CW, Liu HM. Clinical outcomes of adjunct sinus stenting in dural arteriovenous fistulas : Role of flow restoration in steno-occlusion and cortical venous reflux. Clin Neuroradiol 2021. [PMID: 34057563 DOI: 10.1007/s00062-021-01031-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE This study investigated the clinical outcomes and follow-up results of venous sinus stenting (VSS) for constrictive dural sinus restoration in patients with intracranial dural arteriovenous fistulas (DAVFs). We hypothesized that this treatment would have durable benefits in such patients. METHODS Patients who underwent VSS for DAVFs with cortical venous reflux between January 2008 and June 2020 were identified after a retrospective review (n =18). Clinical and endovascular treatment data and follow-up information were reviewed. RESULTS The mean age of the 18 patients was 59.9 years. Stents were implanted in 10 previously occluded sinuses and 9 stenotic sinuses in addition to endovascular embolization. One patient received bilateral VSS. Subdural hemorrhage occurred in one patient after recanalization for embolization, followed by uneventful stenting. In 17 patients with clinical follow-up, the median follow-up time was 59.5 months (interquartile range 18 to 84 months). Of these, sixteen patients had follow-up vascular imaging, revealing AVF obliteration in 6 patients (38%) and stent patency in 11 (69%). Retreatment was performed for 8 (50%) patients. The mean follow-up modified Rankin scale score was 1.28. All patients had longstanding symptomatic improvement. CONCLUSION Restoration of sinus flow in DAVFs with cortical venous reflux through VSS has an acceptable complication rate and long-term symptomatic control; however, retreatment is often required, and stent occlusion is not uncommon.
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Murakami T, Toyota S, Suematsu T, Wada Y, Nakagawa K, Shimizu T, Mori K, Taki T. Balloon anchoring to traverse the sigmoid sinus for delivery of large-caliber venous stents: A technical note. Interv Neuroradiol 2021; 27:712-715. [PMID: 33596699 DOI: 10.1177/1591019921996885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the reconstruction of the superior sagittal sinus or transverse sinus, it is desirable to place a large-diameter guiding catheter into the transverse sinus to introduce the stent delivery system smoothly. The utility of an anchoring technique with a percutaneous transluminal angioplasty (PTA) balloon for navigating an 8 F guiding catheter into the transverse sinus is demonstrated.Case Descriptions: Two dural arteriovenous fistula (dAVF) cases (Cognard type II a +b, Borden type II) that underwent sinus stenting are presented. In both cases, when the 8 F guiding catheter was placed in the jugular vein, the stent delivery system could not enter the transverse sinus because it could not pass through the transverse-sigmoid sinus junction. Introduction of an 8 F guiding catheter into the transverse sinus was attempted but failed. An 8-mm or 9-mm PTA balloon was used as a distal anchor, and this technique allowed easier guiding of catheter advancement into the transverse sinus. In both cases, Carotid WALLSTENTS were placed in the sinus easily, with no complications. CONCLUSION Balloon anchoring in the venous system is useful for achieving large-caliber catheter access across difficult anatomy and is technically feasible.
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Affiliation(s)
- Tomoaki Murakami
- Department of Neurosurgery, 38654Kansai Rosai Hospital, Amagaski, Japan
| | - Shingo Toyota
- Department of Neurosurgery, 38654Kansai Rosai Hospital, Amagaski, Japan
| | - Takuya Suematsu
- Department of Neurosurgery, 38654Kansai Rosai Hospital, Amagaski, Japan
| | - Yuki Wada
- Department of Neurosurgery, 38654Kansai Rosai Hospital, Amagaski, Japan
| | - Kanji Nakagawa
- Department of Neurosurgery, 38654Kansai Rosai Hospital, Amagaski, Japan
| | - Takeshi Shimizu
- Department of Neurosurgery, 38654Kansai Rosai Hospital, Amagaski, Japan
| | - Kanji Mori
- Department of Neurosurgery, 38654Kansai Rosai Hospital, Amagaski, Japan
| | - Takuyu Taki
- Department of Neurosurgery, 38654Kansai Rosai Hospital, Amagaski, Japan
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Xu K, Yang X, Li C, Yu J. Current status of endovascular treatment for dural arteriovenous fistula of the transverse-sigmoid sinus: A literature review. Int J Med Sci 2018; 15:1600-1610. [PMID: 30588182 PMCID: PMC6299407 DOI: 10.7150/ijms.27683] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/14/2018] [Indexed: 12/27/2022] Open
Abstract
Most intracranial dural arteriovenous fistulae (DAVFs) involve the transverse-sigmoid sinus (TSS), and various types of endovascular treatment (EVT) have been involved in managing TSS DAVFs. A current, comprehensive review of the EVT of TSS DAVFs is lacking. This study used the PubMed database to perform a literature review on TSS DAVFs to increase the current understanding of this condition. For high-grade TSS DAVFs such as Borden type 3, the goal of EVT is curative treatment. However, for low-grade TSS DAVFs such as Borden type 1 and some Borden type 2 TSS DAVFs, symptom relief or elimination of cortical reflux may be sufficient. Currently, EVT has become the first-line treatment for TSS DAVFs, including transarterial embolization (TAE), transvenous embolization (TVE) or both. TAE alone and TSS balloon-assisted TAE are also commonly used. However, TVE for TSS DAVFs is recognized as the most effective treatment, including coil direct packing TSS, Onyx® (ethylene vinyl alcohol copolymer) TVE, and balloon-assisted Onyx® TVE, which are commonly applied. In addition, TSS reconstructive treatment can be an effective procedure to treat TSS DAVFs. EVT is accompanied with complications, including technique- and treatment-related complications. Although complications may occur, TSS DAVFs have an acceptable prognosis after EVT.
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Affiliation(s)
- Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Xue Yang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
| | - Chao Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, 130021, China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, 130021, China
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Buell TJ, Raper DM, Ding D, Chen CJ, Liu KC. Development of an Intracranial Dural Arteriovenous Fistula after Venous Sinus Stenting for Idiopathic Intracranial Hypertension. J Neurointerv Surg 2018; 10:e15. [PMID: 29563208 DOI: 10.1136/neurintsurg-2017-013282.rep] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 08/07/2017] [Accepted: 08/08/2017] [Indexed: 11/04/2022]
Abstract
We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation. In addition to the aforementioned mechanisms, increased inflammation induced by VSS may upregulate vascular endothelial growth factor and platelet-derived growth factor expression and also promote DAVF pathogenesis. Since VSS has been used to obliterate DAVFs, DAVF formation after VSS may seem counterintuitive. Previous stents have generally been closed cell, stainless steel designs used to maximize radial compression of the fistulous sinus wall. In contrast, our patient's stent was an open cell, self-expandable nitinol design (Protégé Everflex). Neurointerventionalists should be aware of this potential, although rare complication of DAVF formation after VSS.
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Affiliation(s)
- Thomas J Buell
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel M Raper
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Dale Ding
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kenneth C Liu
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
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Renieri L, Michelozzi C, Brinjikji W, Darcout J, Guenego A, Vukasinovic I, Tall P, Bonneville F, Januel AC, Cognard C. PTA Stent of Dural Sinuses in Brain DAVF : A Report of 4 Cases. Clin Neuroradiol 2017; 29:331-339. [PMID: 29243076 DOI: 10.1007/s00062-017-0652-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 11/24/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Type I and IIa dural arteriovenous fistulas (DAVFs) have a low hemorrhagic risk, but are often the cause of debilitating tinnitus that requires treatment. While Onyx® and PHIL™ (Precipitating hydrophobic injectable liquid) transarterial embolization represent the first endovascular option, there are occasional cases where performing angioplasty and stenting of the affected sinus may lead to satisfactory results. MATERIAL AND METHODS We retrospectively analyzed four consecutive cases of patients with DAVF-induced pulsatile tinnitus secondary to type I and II DAVFs who were treated with angioplasty and stenting of the sinus only. All the patients had clinical and radiological long-term follow-up. RESULTS We noticed a significant radiological and clinical improvement in all the cases. Of the patients two were completely cured at follow-up with eradication of the neurological symptoms as well as the fistula, one was retreated with Onyx® for a very small residual shunt despite having no more tinnitus, and one showed improvement in venous drainage (from type IIa+b to type I fistula) without resolution of the fistula. CONCLUSION In cases of type I and II DAVFs associated with sinus stenosis, angioplasty and stenting alone seem to be safe and effective. This treatment probably compresses the venules within the sinus walls, promoting thrombosis of the shunts thus solving the underlying cause of the fistula.
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Affiliation(s)
- Leonardo Renieri
- Department of Neuroradiology, Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, University Hospital of Toulouse, Place du Dr Baylac, TSA 40031, 31059, Toulouse, France. .,Department of Medical Imaging, Division of Neuroradiology, Toronto Western Hospital, University Health Network & University of Toronto, 399 Bathurst Street, McL Wing, 3rd Floor, Room 438, M5T2S8, Toronto, ON, Canada.
| | - Caterina Michelozzi
- Department of Neuroradiology, Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, University Hospital of Toulouse, Place du Dr Baylac, TSA 40031, 31059, Toulouse, France
| | - Waleed Brinjikji
- Department of Medical Imaging, Division of Neuroradiology, Toronto Western Hospital, University Health Network & University of Toronto, 399 Bathurst Street, McL Wing, 3rd Floor, Room 438, M5T2S8, Toronto, ON, Canada
| | - Jean Darcout
- Department of Neuroradiology, Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, University Hospital of Toulouse, Place du Dr Baylac, TSA 40031, 31059, Toulouse, France
| | - Adrien Guenego
- Department of Neuroradiology, Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, University Hospital of Toulouse, Place du Dr Baylac, TSA 40031, 31059, Toulouse, France
| | - Ivan Vukasinovic
- Department of Neuroradiology, Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, University Hospital of Toulouse, Place du Dr Baylac, TSA 40031, 31059, Toulouse, France
| | - Philippe Tall
- Department of Neuroradiology, Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, University Hospital of Toulouse, Place du Dr Baylac, TSA 40031, 31059, Toulouse, France
| | - Fabrice Bonneville
- Department of Neuroradiology, Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, University Hospital of Toulouse, Place du Dr Baylac, TSA 40031, 31059, Toulouse, France
| | - Anne-Christine Januel
- Department of Neuroradiology, Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, University Hospital of Toulouse, Place du Dr Baylac, TSA 40031, 31059, Toulouse, France
| | - Christophe Cognard
- Department of Neuroradiology, Service de Neuroradiologie Diagnostique et Thérapeutique du CHU de Toulouse, University Hospital of Toulouse, Place du Dr Baylac, TSA 40031, 31059, Toulouse, France
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Buell TJ, Raper DM, Ding D, Chen CJ, Liu KC. Development of an intracranial dural arteriovenous fistula after venous sinus stenting for idiopathic intracranial hypertension. BMJ Case Rep 2017; 2017:bcr-2017-013282. [PMID: 28951386 DOI: 10.1136/bcr-2017-013282] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a case in which an intracranial dural arteriovenous fistula (DAVF) developed after endovascular treatment of a patient with idiopathic intracranial hypertension with venous sinus stenting (VSS). The pathogenesis may involve hemodynamic alterations secondary to increased poststenting venous sinus pressure, which may cause new arterial ingrowth into the fistulous sinus wall without capillary interposition. Despite administration of dual antiplatelet therapy, there may also be subclinical cortical vein thrombosis that contributed to DAVF formation. In addition to the aforementioned mechanisms, increased inflammation induced by VSS may upregulate vascular endothelial growth factor and platelet-derived growth factor expression and also promote DAVF pathogenesis. Since VSS has been used to obliterate DAVFs, DAVF formation after VSS may seem counterintuitive. Previous stents have generally been closed cell, stainless steel designs used to maximize radial compression of the fistulous sinus wall. In contrast, our patient's stent was an open cell, self-expandable nitinol design (Protégé Everflex). Neurointerventionalists should be aware of this potential, although rare complication of DAVF formation after VSS.
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Affiliation(s)
- Thomas J Buell
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Daniel M Raper
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Dale Ding
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kenneth C Liu
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
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Abstract
Dural arteriovenous fistula (DAVF) is a rare type of acquired intracranial vascular malformation. Recent progress in neuroimaging technology, such as advanced MRI and CT, provides non-invasive methods to accurately diagnose DAVF, including evaluation of the hemodynamics of the drainage veins. The clinical manifestations of DAVFs vary widely and depend on the location and venous drainage pattern of arteriovenous shunting. Patients with high grade DAVFs having cortical venous reflux should receive aggressive treatment to prevent the occurrence of intracranial hemorrhage and other neurological deficits related to venous congestion. Intra-arterial or intravenous endovascular embolization remains the primary therapy for high grade DAVF, while open surgery and stereotactic radiosurgery can serve as alternative treatment options. Early and accurate diagnosis with appropriate treatment is the goal for clinical management of DAVFs to reduce symptoms and prevent the development of venous congestion and stroke.
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Affiliation(s)
- Li-Kai Tsai
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
| | - Hon-Man Liu
- b Department of Medical Imaging , National Taiwan University Hospital , Taipei , Taiwan
| | - Jiann-Shing Jeng
- a Department of Neurology and Stroke Center , National Taiwan University Hospital , Taipei , Taiwan
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Abstract
The intracranial venous sinus is an important component of vascular disease. Many diseases involve the venous sinus and are accompanied by venous sinus stenosis (VSS), which leads to increased venous pressure and high intracranial pressure. Recent research has focused on stenting as a treatment for VSS related to these diseases. However, a systematic understanding of venous sinus stenting (VS-Stenting) is lacking. Herein, the literature on idiopathic intracranial hypertension (IIH), venous pulsatile tinnitus, sinus thrombosis, high draining venous pressure in dural arteriovenous fistula (AVF) and arteriovenous malformation (AVM), and tumor-caused VSS was reviewed and analyzed to summarize experiences with VS-Stenting as a treatment. The literature review showed that satisfactory therapeutic effects can be achieved through stent angioplasty. Thus, the present study suggests that selective stent release in the venous sinus can effectively treat these diseases and provide new possibilities for treating intracranial vascular disease.
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Affiliation(s)
- Kan Xu
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Tiecheng Yu
- 2. Department of Orthopedics, First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Yongjie Yuan
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China
| | - Jinlu Yu
- 1. Department of Neurosurgery, First Hospital of Jilin University, Changchun, 130021, P.R. China
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