Middle cranial fossa sphenoidal region dural arteriovenous fistulas: anatomic and treatment considerations.
AJNR Am J Neuroradiol
; 34(2): 373-80, 2013 Feb.
Article
in En
| MEDLINE
| ID: mdl-22790245
ABSTRACT
BACKGROUND AND PURPOSE:
DAVFs rarely involve the sphenoid wings and middle cranial fossa. We characterize the angiographic findings, treatment, and outcome of DAVFs within the sphenoid wings. MATERIALS ANDMETHODS:
We reviewed the clinical and radiologic data of 11 patients with DAVFs within the sphenoid wing that were treated with an endovascular or with a combined endovascular and surgical approach.RESULTS:
Nine patients presented with ocular symptoms and 1 patient had a temporal parenchymal hematoma. Angiograms showed that 5 DAVFs were located on the lesser wing of sphenoid bone, whereas the other 6 were on the greater wing of the sphenoid bone. Multiple branches of the ICA and ECA supplied the lesions in 7 patients. Four patients had cortical venous reflux and 7 patients had varices. Eight patients were treated with transarterial embolization using liquid embolic agents, while 3 patients were treated with transvenous embolization with coils or in combination with Onyx. Surgical disconnection of the cortical veins was performed in 2 patients with incompletely occluded DAVFs. Anatomic cure was achieved in all patients. Eight patients had angiographic and clinical follow-up and none had recurrence of their lesions.CONCLUSIONS:
DAVFs may occur within the dura of the sphenoid wings and may often have a presentation similar to cavernous sinus DAVFs, but because of potential associations with the cerebral venous system, may pose a risk for intracranial hemorrhage. Curative embolization through a transarterial or transvenous approach is the primary therapeutic strategy for these lesions. In incompletely embolized patients, exclusion of any refluxing cortical veins is necessary.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Sphenoid Bone
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Central Nervous System Vascular Malformations
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Cranial Fossa, Middle
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Embolization, Therapeutic
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Endovascular Procedures
Type of study:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limits:
Adult
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Aged
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Female
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Humans
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Male
/
Middle aged
Language:
En
Journal:
AJNR Am J Neuroradiol
Year:
2013
Document type:
Article
Affiliation country: