Endovascular treatment of anterior cranial fossa dural arteriovenous fistula: a multicenter series
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INTERVENTIONAL NEURORADIOLOGY
Endovascular treatment of anterior cranial fossa dural arteriovenous fistula: a multicenter series Guilherme Dabus 1,2 & Peter Kan 3 & Carlos Diaz 4 & Boris Pabon 5 & Juan Andres-Mejia 5 & Italo Linfante 1 & Jonathan A. Grossberg 6 & Brian M. Howard 6 & Civan Islak 7 & Naci Kocer 7 & Osman Kizilkilic 7 & Ajit S. Puri 8 & Anna L. Kuhn 8 & Viraj Moholkar 8 & Santiago Ortega-Gutierrez 9 & Edgar A. Samaniego 9 & Michael W. McDermott 1 Received: 10 June 2020 / Accepted: 20 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose We report a multicenter experience using endovascular embolization as the first line approach for treatment of anterior cranial fossa (ACF) dural arteriovenous fistula (DAVF). Methods All patients with DAVFs located in the anterior cranial fossa who were treated with endovascular technique as a first line approach were included. Demographics, clinical presentation, angioarchitecture, strategy, complications, immediate angiographic, and follow-up results were included in the analysis. Results Twenty-three patients met the inclusion criteria (18 male and 5 female). Age ranged from 14 to 79 years (mean 53 years). Twelve patients presented with hemorrhage. Twenty-eight endovascular procedures were performed. The overall immediate angiographic cure rate after endovascular treatment was 82.6% (19/23 patients). The angiographic cure rate of the transvenous strategy was significantly superior to the transarterial strategy (p ≤ 0.001). There was 1 complication in 28 total procedures (3.6%). Angiographic follow-up was available in 21 out of the 23 patients with a mean of 25 months (range 2 to 108 months). In these 21 patients, the DAVF was completely cured in 20 (95%). At last follow-up, all patients had a modified Rankin scale (mRS) 0 to 2. Conclusion Our experience suggests that endovascular treatment for ACF DAVFs has an acceptable safety profile with high rates of complete occlusion, particularly with transvenous approach. Whenever possible, transvenous approach should be preferred over transarterial approach as first line strategy. Keywords Anterior cranial fossa . Ethmoidal . Dural arteriovenous fistula . Transarterial . Transvenous . Embolization . Endovascular
Introduction Dural arteriovenous fistulas (DAVFs) located in the anterior cranial fossa (ACF) are rare lesions [1–6]. Because there is no significant venous sinus in the anterior cranial fossa, these lesions
* Guilherme Dabus [email protected]
almost always demonstrate cortical venous drainage and therefore are aggressive lesions that require prompt attention and treatment since the hemorrhagic risk is significant [1–10]. The safety and efficacy of endovascular treatment for most types of DAVFs has been extensively documented in the
4
Interventional Neuroradiology at Incare, Universidad de Antioquia, Medellin, Colombia
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Interventional Neuroradiology at Angioteam, Medellin, Colombia
Division of Interventional Neuroradiology/NeuroEndovascular Surgery, Miami Ne
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