Percutaneous transfacial direct embolization of an intraosseous dural arteriovenous fistula. Neurosurgery 2014 Mar;10 Suppl 1:E178-82
Date
10/22/2013Pubmed ID
24141481DOI
10.1227/NEU.0000000000000213Scopus ID
2-s2.0-84907861915 (requires institutional sign-in at Scopus site) 9 CitationsAbstract
BACKGROUND AND IMPORTANCE: An intraosseous dural arteriovenous fistula (DAVF) is a rare cerebrovascular disease. The fistulous connection occurs within intraosseous diploic or transosseous emissary veins causing dilated intraosseous vascular pouches. To the authors' knowledge, this report describes the first percutaneous transfacial direct embolization of an intraosseous DAVF.
CLINICAL PRESENTATION: A man in his 50s with blue rubber bleb nevus syndrome presented with headaches, imbalance, decreased visual acuity bilaterally, and left eye proptosis and chemosis. Imaging demonstrated an extensive intraosseous DAVF with dilated intraosseous vascular pouches throughout his cranial base and intraorbital venous congestion. He underwent staged endovascular treatment with the goal to improve his ocular symptoms. Transarterial and transvenous approaches failed to provide adequate access to the intraosseous vascular pouches. A direct, percutaneous transfacial approach was used to access the pouches for embolization with coils and liquid embolic material. Postoperative angiography demonstrated successful embolization of the pouch within the left pterygoid wing, reduced opacification of the intraosseous fistula, and elimination of intraorbital venous congestion. At 9-month follow-up, the patient's headaches had resolved, and his ocular symptomatology had improved.
CONCLUSION: Endovascular access to an intraosseous DAVF is limited by the size and location of the intraosseous vascular pouches. In this case, a direct transfacial approach under image guidance facilitated access and embolization, which led to an improvement in the patient's symptoms. This technique is a novel approach for DAVF management.
Author List
Nerva JD, Hallam DK, Ghodke BVAuthor
John D. Nerva MD Assistant Professor in the Neurosurgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Arteriovenous FistulaCentral Nervous System Vascular Malformations
Cerebral Angiography
Embolization, Therapeutic
Exophthalmos
Gastrointestinal Neoplasms
Head
Headache
Humans
Magnetic Resonance Angiography
Male
Middle Aged
Nevus, Blue
Orbital Diseases
Skin Neoplasms
Therapy, Computer-Assisted
Vision Disorders
