Endovascular treatment of anterior cranial base dural arteriovenous fistulas as a first-line approach: a multicenter study
Anterior cranial fossa dural arteriovenous fistulas (DAVFs) have been almost exclusively considered as surgical lesions. However, new advances in endovascular technology have made the endovascular treatment (EVT) of ethmoidal DAVFs feasible. The aim of this study was to report the clinical and angio...
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| Veröffentlicht in: | Journal of neurosurgery 2022-12, Vol.137 (6), p.1758-1765 |
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| creator | Trivelato, Felipe P Smajda, Stanislas Saleme, Suzana Castro-Afonso, Luís Henrique de Abud, Thiago G Ulhôa, Alexandre C Blanc, Raphael Abud, Daniel G Mounayer, Charbel Piotin, Michel Rezende, Marco Túlio S |
| description | Anterior cranial fossa dural arteriovenous fistulas (DAVFs) have been almost exclusively considered as surgical lesions. However, new advances in endovascular technology have made the endovascular treatment (EVT) of ethmoidal DAVFs feasible. The aim of this study was to report the clinical and angiographic outcomes of patients harboring DAVFs of the anterior cranial fossa who had undergone EVT as a first-line approach.
This was a retrospective study of a consecutive series of patients harboring anterior cranial base DAVFs who had undergone EVT as a first-line approach at four institutions. Angiographic follow-up was performed at 6 months. Immediate and late serious clinical events were assessed during follow-up, including death and stroke. Special emphasis was given to visual status before and after the treatment.
Between 2008 and 2020, 37 patients with ethmoidal DAVFs were admitted to the participating centers. In 2 patients, EVT was not attempted; therefore, 35 patients underwent EVT as a first-line procedure. An isolated transarterial approach was performed in 19 (54.3%) patients. The transvenous approach was performed exclusively in 12 (34.3%) patients, and combined access was used in 4 (11.4%) patients. The most frequently used arterial access route was the ophthalmic artery in 82.6% of the patients. Immediately, complete angiographic occlusion was achieved in 31 (91.2%) of 34 patients whose treatment was accomplished. Six-month control angiography revealed that 30 (88.2%) DAVFs were totally occluded. Complications occurred in 3 (8.8%) patients, including 1 (2.9%) patient who had central retinal artery occlusion. No significant difference in complications or occlusion rates was noted between the transarterial and transvenous approaches.
Most anterior cranial base DAVFs can be successfully treated via an endovascular approach. Neurological and visual complications are rare, even if the ophthalmic artery is used as the primary access route. Efforts should be focused on prospectively comparing the results of EVT and surgical management. |
| doi_str_mv | 10.3171/2022.2.JNS212588 |
| format | Article |
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This was a retrospective study of a consecutive series of patients harboring anterior cranial base DAVFs who had undergone EVT as a first-line approach at four institutions. Angiographic follow-up was performed at 6 months. Immediate and late serious clinical events were assessed during follow-up, including death and stroke. Special emphasis was given to visual status before and after the treatment.
Between 2008 and 2020, 37 patients with ethmoidal DAVFs were admitted to the participating centers. In 2 patients, EVT was not attempted; therefore, 35 patients underwent EVT as a first-line procedure. An isolated transarterial approach was performed in 19 (54.3%) patients. The transvenous approach was performed exclusively in 12 (34.3%) patients, and combined access was used in 4 (11.4%) patients. The most frequently used arterial access route was the ophthalmic artery in 82.6% of the patients. Immediately, complete angiographic occlusion was achieved in 31 (91.2%) of 34 patients whose treatment was accomplished. Six-month control angiography revealed that 30 (88.2%) DAVFs were totally occluded. Complications occurred in 3 (8.8%) patients, including 1 (2.9%) patient who had central retinal artery occlusion. No significant difference in complications or occlusion rates was noted between the transarterial and transvenous approaches.
Most anterior cranial base DAVFs can be successfully treated via an endovascular approach. Neurological and visual complications are rare, even if the ophthalmic artery is used as the primary access route. Efforts should be focused on prospectively comparing the results of EVT and surgical management.</description><identifier>ISSN: 0022-3085</identifier><identifier>ISSN: 1933-0693</identifier><identifier>EISSN: 1933-0693</identifier><identifier>DOI: 10.3171/2022.2.JNS212588</identifier><identifier>PMID: 35395632</identifier><language>eng</language><publisher>United States: American Association of Neurological Surgeons</publisher><subject>Central Nervous System Vascular Malformations - diagnostic imaging ; Central Nervous System Vascular Malformations - surgery ; Cranial Fossa, Anterior - diagnostic imaging ; Cranial Fossa, Anterior - pathology ; Cranial Fossa, Anterior - surgery ; Embolization, Therapeutic - methods ; Endovascular Procedures - methods ; Human health and pathology ; Humans ; Hépatology and Gastroenterology ; Life Sciences ; Ophthalmic Artery - pathology ; Retrospective Studies ; Treatment Outcome</subject><ispartof>Journal of neurosurgery, 2022-12, Vol.137 (6), p.1758-1765</ispartof><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c329t-e50d0bd7e9ee26ebb4b0022df3b953c80709b6c203fb53bf8df652efaf7b2fcc3</citedby><cites>FETCH-LOGICAL-c329t-e50d0bd7e9ee26ebb4b0022df3b953c80709b6c203fb53bf8df652efaf7b2fcc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35395632$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04504233$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Trivelato, Felipe P</creatorcontrib><creatorcontrib>Smajda, Stanislas</creatorcontrib><creatorcontrib>Saleme, Suzana</creatorcontrib><creatorcontrib>Castro-Afonso, Luís Henrique de</creatorcontrib><creatorcontrib>Abud, Thiago G</creatorcontrib><creatorcontrib>Ulhôa, Alexandre C</creatorcontrib><creatorcontrib>Blanc, Raphael</creatorcontrib><creatorcontrib>Abud, Daniel G</creatorcontrib><creatorcontrib>Mounayer, Charbel</creatorcontrib><creatorcontrib>Piotin, Michel</creatorcontrib><creatorcontrib>Rezende, Marco Túlio S</creatorcontrib><title>Endovascular treatment of anterior cranial base dural arteriovenous fistulas as a first-line approach: a multicenter study</title><title>Journal of neurosurgery</title><addtitle>J Neurosurg</addtitle><description>Anterior cranial fossa dural arteriovenous fistulas (DAVFs) have been almost exclusively considered as surgical lesions. However, new advances in endovascular technology have made the endovascular treatment (EVT) of ethmoidal DAVFs feasible. The aim of this study was to report the clinical and angiographic outcomes of patients harboring DAVFs of the anterior cranial fossa who had undergone EVT as a first-line approach.
This was a retrospective study of a consecutive series of patients harboring anterior cranial base DAVFs who had undergone EVT as a first-line approach at four institutions. Angiographic follow-up was performed at 6 months. Immediate and late serious clinical events were assessed during follow-up, including death and stroke. Special emphasis was given to visual status before and after the treatment.
Between 2008 and 2020, 37 patients with ethmoidal DAVFs were admitted to the participating centers. In 2 patients, EVT was not attempted; therefore, 35 patients underwent EVT as a first-line procedure. An isolated transarterial approach was performed in 19 (54.3%) patients. The transvenous approach was performed exclusively in 12 (34.3%) patients, and combined access was used in 4 (11.4%) patients. The most frequently used arterial access route was the ophthalmic artery in 82.6% of the patients. Immediately, complete angiographic occlusion was achieved in 31 (91.2%) of 34 patients whose treatment was accomplished. Six-month control angiography revealed that 30 (88.2%) DAVFs were totally occluded. Complications occurred in 3 (8.8%) patients, including 1 (2.9%) patient who had central retinal artery occlusion. No significant difference in complications or occlusion rates was noted between the transarterial and transvenous approaches.
Most anterior cranial base DAVFs can be successfully treated via an endovascular approach. Neurological and visual complications are rare, even if the ophthalmic artery is used as the primary access route. Efforts should be focused on prospectively comparing the results of EVT and surgical management.</description><subject>Central Nervous System Vascular Malformations - diagnostic imaging</subject><subject>Central Nervous System Vascular Malformations - surgery</subject><subject>Cranial Fossa, Anterior - diagnostic imaging</subject><subject>Cranial Fossa, Anterior - pathology</subject><subject>Cranial Fossa, Anterior - surgery</subject><subject>Embolization, Therapeutic - methods</subject><subject>Endovascular Procedures - methods</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Hépatology and Gastroenterology</subject><subject>Life Sciences</subject><subject>Ophthalmic Artery - pathology</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>0022-3085</issn><issn>1933-0693</issn><issn>1933-0693</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kUlLBDEQhYMoOi53T5KjHnpMpzq9eJPBlUEP6jkk6Qq29DIm6QH99aYdHQgkVfW9R4pHyGnK5pAW6SVnnM_5_PHphadclOUOmaUVQMLyCnbJjMVxAqwUB-TQ-w_G0jzL-T45AAGVyIHPyPdNXw9r5c3YKkeDQxU67AMdLFV9QNcMjhqn-ka1VCuPtB5dfCr3O1tjP4ye2saHqPd0OrFyPiRt0yNVq5UblHm_iu1ubENjcDKlEa-_jsmeVa3Hk7_7iLzd3rwu7pPl893D4nqZGOBVSFCwmum6wAqR56h1pqe9agu6EmBKVrBK54YzsFqAtmVtc8HRKltobo2BI3Kx8X1XrVy5plPuSw6qkffXSzn1WCZYxgHWaWTPN2z89-eIPsiu8QbbVvUYN5U8z8qyyrKiiCjboMYN3ju0W--UySkdOaUjudymEyVnf-6j7rDeCv7jgB9MfY0_</recordid><startdate>20221201</startdate><enddate>20221201</enddate><creator>Trivelato, Felipe P</creator><creator>Smajda, Stanislas</creator><creator>Saleme, Suzana</creator><creator>Castro-Afonso, Luís Henrique de</creator><creator>Abud, Thiago G</creator><creator>Ulhôa, Alexandre C</creator><creator>Blanc, Raphael</creator><creator>Abud, Daniel G</creator><creator>Mounayer, Charbel</creator><creator>Piotin, Michel</creator><creator>Rezende, Marco Túlio S</creator><general>American Association of Neurological Surgeons</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope></search><sort><creationdate>20221201</creationdate><title>Endovascular treatment of anterior cranial base dural arteriovenous fistulas as a first-line approach: a multicenter study</title><author>Trivelato, Felipe P ; Smajda, Stanislas ; Saleme, Suzana ; Castro-Afonso, Luís Henrique de ; Abud, Thiago G ; Ulhôa, Alexandre C ; Blanc, Raphael ; Abud, Daniel G ; Mounayer, Charbel ; Piotin, Michel ; Rezende, Marco Túlio S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c329t-e50d0bd7e9ee26ebb4b0022df3b953c80709b6c203fb53bf8df652efaf7b2fcc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Central Nervous System Vascular Malformations - diagnostic imaging</topic><topic>Central Nervous System Vascular Malformations - surgery</topic><topic>Cranial Fossa, Anterior - diagnostic imaging</topic><topic>Cranial Fossa, Anterior - pathology</topic><topic>Cranial Fossa, Anterior - surgery</topic><topic>Embolization, Therapeutic - methods</topic><topic>Endovascular Procedures - methods</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Hépatology and Gastroenterology</topic><topic>Life Sciences</topic><topic>Ophthalmic Artery - pathology</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Trivelato, Felipe P</creatorcontrib><creatorcontrib>Smajda, Stanislas</creatorcontrib><creatorcontrib>Saleme, Suzana</creatorcontrib><creatorcontrib>Castro-Afonso, Luís Henrique de</creatorcontrib><creatorcontrib>Abud, Thiago G</creatorcontrib><creatorcontrib>Ulhôa, Alexandre C</creatorcontrib><creatorcontrib>Blanc, Raphael</creatorcontrib><creatorcontrib>Abud, Daniel G</creatorcontrib><creatorcontrib>Mounayer, Charbel</creatorcontrib><creatorcontrib>Piotin, Michel</creatorcontrib><creatorcontrib>Rezende, Marco Túlio S</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Journal of neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Trivelato, Felipe P</au><au>Smajda, Stanislas</au><au>Saleme, Suzana</au><au>Castro-Afonso, Luís Henrique de</au><au>Abud, Thiago G</au><au>Ulhôa, Alexandre C</au><au>Blanc, Raphael</au><au>Abud, Daniel G</au><au>Mounayer, Charbel</au><au>Piotin, Michel</au><au>Rezende, Marco Túlio S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endovascular treatment of anterior cranial base dural arteriovenous fistulas as a first-line approach: a multicenter study</atitle><jtitle>Journal of neurosurgery</jtitle><addtitle>J Neurosurg</addtitle><date>2022-12-01</date><risdate>2022</risdate><volume>137</volume><issue>6</issue><spage>1758</spage><epage>1765</epage><pages>1758-1765</pages><issn>0022-3085</issn><issn>1933-0693</issn><eissn>1933-0693</eissn><abstract>Anterior cranial fossa dural arteriovenous fistulas (DAVFs) have been almost exclusively considered as surgical lesions. However, new advances in endovascular technology have made the endovascular treatment (EVT) of ethmoidal DAVFs feasible. The aim of this study was to report the clinical and angiographic outcomes of patients harboring DAVFs of the anterior cranial fossa who had undergone EVT as a first-line approach.
This was a retrospective study of a consecutive series of patients harboring anterior cranial base DAVFs who had undergone EVT as a first-line approach at four institutions. Angiographic follow-up was performed at 6 months. Immediate and late serious clinical events were assessed during follow-up, including death and stroke. Special emphasis was given to visual status before and after the treatment.
Between 2008 and 2020, 37 patients with ethmoidal DAVFs were admitted to the participating centers. In 2 patients, EVT was not attempted; therefore, 35 patients underwent EVT as a first-line procedure. An isolated transarterial approach was performed in 19 (54.3%) patients. The transvenous approach was performed exclusively in 12 (34.3%) patients, and combined access was used in 4 (11.4%) patients. The most frequently used arterial access route was the ophthalmic artery in 82.6% of the patients. Immediately, complete angiographic occlusion was achieved in 31 (91.2%) of 34 patients whose treatment was accomplished. Six-month control angiography revealed that 30 (88.2%) DAVFs were totally occluded. Complications occurred in 3 (8.8%) patients, including 1 (2.9%) patient who had central retinal artery occlusion. No significant difference in complications or occlusion rates was noted between the transarterial and transvenous approaches.
Most anterior cranial base DAVFs can be successfully treated via an endovascular approach. Neurological and visual complications are rare, even if the ophthalmic artery is used as the primary access route. Efforts should be focused on prospectively comparing the results of EVT and surgical management.</abstract><cop>United States</cop><pub>American Association of Neurological Surgeons</pub><pmid>35395632</pmid><doi>10.3171/2022.2.JNS212588</doi><tpages>8</tpages></addata></record> |
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| subjects | Central Nervous System Vascular Malformations - diagnostic imaging Central Nervous System Vascular Malformations - surgery Cranial Fossa, Anterior - diagnostic imaging Cranial Fossa, Anterior - pathology Cranial Fossa, Anterior - surgery Embolization, Therapeutic - methods Endovascular Procedures - methods Human health and pathology Humans Hépatology and Gastroenterology Life Sciences Ophthalmic Artery - pathology Retrospective Studies Treatment Outcome |
| title | Endovascular treatment of anterior cranial base dural arteriovenous fistulas as a first-line approach: a multicenter study |
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