Faculty Collaboration Database

Alternative management considerations for ethmoidal dural arteriovenous fistulas. Surg Neurol 2002 Dec;58(6):410-6; discussion 416

Date

01/09/2003

Pubmed ID

12517625

DOI

10.1016/s0090-3019(02)00871-6

Scopus ID

2-s2.0-0036924292 (requires institutional sign-in at Scopus site)   53 Citations

Abstract

BACKGROUND: Ethmoidal dural arteriovenous fistulas (EDAFs) are an unusual type of intracranial vascular lesion that commonly present with acute hemorrhage. They are often best treated surgically; however, recent endovascular advances raise questions concerning the best therapeutic approach.

METHODS: We present 7 cases of EDAFs managed at this institution over a 6-year period, which demonstrate the broad spectrum of clinical behavior associated with the lesions. Four patients presented with intracranial hemorrhage, 1 patient with rapidly progressive dementia, 1 patient with a proptotic, red eye, and 1 with a retro-orbital headache.

RESULTS: One patient underwent no treatment, 1 underwent embolization alone, 2 underwent embolization and resection, and 3 patients underwent resection alone. There was complete obliteration of the EDAF in all of the patients who underwent surgical resection. Embolization was performed through the external carotid circulation and not the ophthalmic artery. There were no treatment-related neurologic deficits.

CONCLUSIONS: Treatment is best managed with a multidisciplinary approach, which emphasizes complete resection of the lesions with assistance from interventional neuroradiology techniques. However, each patient must be evaluated independently as treatment may vary depending on the angioarchitecture of the lesion.

Author List

Abrahams JM, Bagley LJ, Flamm ES, Hurst RW, Sinson GP

Author

Grant P. Sinson MD Associate Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Central Nervous System Vascular Malformations
Cranial Fossa, Anterior
Embolization, Therapeutic
Ethmoid Bone
Female
Humans
Male
Middle Aged
Neurosurgical Procedures
Radiography