Long-term angiographic results of endovascularly 'cured' intracranial dural arteriovenous fistulas
| Autor: | Mohamed Samy Elhammady, Brandon G. Gaynor, Sudheer Ambekar, Eric C. Peterson |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male Cerebral veins medicine.medical_specialty Adolescent Fistula medicine.medical_treatment Kaplan-Meier Estimate Tantalum 030218 nuclear medicine & medical imaging Young Adult 03 medical and health sciences 0302 clinical medicine Recurrence Dural arteriovenous fistulas medicine Humans Embolization Child Vein Aged Retrospective Studies Aged 80 and over Central Nervous System Vascular Malformations medicine.diagnostic_test business.industry Endovascular Procedures Infant General Medicine Middle Aged medicine.disease Embolization Therapeutic Cerebral Angiography Surgery Drug Combinations Treatment Outcome medicine.anatomical_structure Child Preschool Dural venous sinuses Angiography Female Polyvinyls business 030217 neurology & neurosurgery Follow-Up Studies Cerebral angiography |
| Zdroj: | Journal of Neurosurgery. 124:1123-1127 |
| ISSN: | 1933-0693 0022-3085 |
| DOI: | 10.3171/2015.3.jns1558 |
| Popis: | OBJECT Dural arteriovenous fistulas (DAVFs) are complex lesions consisting of abnormal connections between meningeal arteries and dural venous sinuses and/or cerebral veins. The goal of treatment is surgical or endovascular occlusion of the fistula or fistulous nidus or at least the disconnection of the feeding vessels and the draining veins. Delayed angiographic data on previously embolized dural fistulas is lacking. The authors report their experience and the long-term angiographic results with embolization of intracranial DAVF using Onyx. METHODS All cases of DAVF treated primarily with Onyx at the authors’ institution from 2006 to 2013 were retrospectively reviewed. Patient demographics, fistula characteristics, embolization details, and angiographic follow-up were analyzed. RESULTS Fifty-eight patients with DAVFs were treated during the study period. Twenty-two patients were treated with open surgery with or without prior embolization. Thirty-six patients were treated with embolization alone, of whom 26 underwent an attempt at curative embolization and are the subject of this review. All but 2 of these patients were treated in a single session. Angiographic “cure” was achieved in all cases following treatment. Follow-up angiography was performed in 21 patients at a mean of 14 months after treatment (range 2–39 months). Asymptomatic angiographic recurrence of the fistula was evident in 3 of the 21 patients (14.3%). On reviewing the procedural angiograms of the cases in which the DAVFs recurred, it was observed that the Onyx cast did not reach the venous portion in 1 case, whereas it did reach the vein in the other 2 cases. CONCLUSIONS Recurrence following initial angiographic cure of DAVF is not uncommon. Incomplete penetration of the embolic material into the proximal portion of the venous outlet may lead to delayed recurrence. Long-term angiographic follow-up is highly recommended. |
| Databáze: | OpenAIRE |
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