Endovascular Treatment of Dural Arteriovenous Fistulas : Single Center Experience

Oh, Jae-Sang; Yoon, Seok-Mann; Oh, Hyuk-Jin; Shim, Jai-Joon; Bae, Hack-Gun; Lee, Kyeong-Seok

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자료유형: 학술저널

저자정보: Oh, Jae-Sang (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) Yoon, Seok-Mann (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) Oh, Hyuk-Jin (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) Shim, Jai-Joon (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) Bae, Hack-Gun (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital) Lee, Kyeong-Seok (Department of Neurosurgery, Soonchunhyang University Cheonan Hospital)

저널정보: 대한신경외과학회 대한신경외과학회지 대한신경외과학회지 제59권 제1호

발행연도: 2016.1

수록면: 17 - 25 (9page)

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Objective : Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. Methods : Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. Results : All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed ${\geq}2$ times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. Conclusion : Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route.

#Endovascualr #Dural arteriovenous fistulas #Onyx #Embolization #Transarterial

참고문헌 (16)

참고문헌 신청

Awad IA / 1990 / Intracranial dural arteriovenous malformations : factors predisposing to an aggressive neurological course / J Neurosurg 72:839~850

Borden JA / 1995 / A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment / J Neurosurg 82:166~179

Chung SJ / 2002 / Intracranial dural arteriovenous fistulas : analysis of 60 patients / Cerebrovasc Dis 13:79~88

Cognard C / 1995 / Cerebral dural arteriovenous fistulas : clinical and angiographic correlation with a revised classification of venous drainage / Radiology 194:671~680

Fujita A / 1997 / Cerebral sinus thrombosis in a patient with protein S deficiency : a case report / No Shinkei Geka 25:467~472

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