NDLI: Long-term angiographic results of endovascularly 'cured' intracranial dural arteriovenous fistulas.

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Long-term angiographic results of endovascularly 'cured' intracranial dural arteriovenous fistulas.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Ambekar, Sudheer Gaynor, Brandon G. Peterson, Eric C. Elhammady, Mohamed Samy
Description	Author Affiliation: Ambekar S ( Division of Endovascular Neurosurgery, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.); Gaynor BG ( Division of Endovascular Neurosurgery, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.); Peterson EC ( Division of Endovascular Neurosurgery, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.); Elhammady MS ( Division of Endovascular Neurosurgery, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida.)
Abstract	OBJECTIVE: 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.
File Format	HTM / HTML
ISSN	00223085
e-ISSN	19330693
Journal	Journal of Neurosurgery
Issue Number	4
Volume Number	124
Language	English
Publisher	American Association of Neurological Surgeons
Publisher Date	2016-04-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurosurgery Central Nervous System Vascular Malformations Surgery Embolization, Therapeutic Endovascular Procedures Adolescent Pathology Cerebral Angiography Child, Preschool Drug Combinations Infant Kaplan-meier Estimate Polyvinyls Recurrence Retrospective Studies Tantalum
Content Type	Text
Resource Type	Article
Subject	Neurology (clinical) Surgery

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