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Middle Cranial Fossa Sphenoidal Region Dural Arteriovenous Fistulas: Anatomic and Treatment Considerations.
MedLine Citation:
PMID:  22790245     Owner:  NLM     Status:  Publisher    
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 AND METHODS: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.
Z-S Shi; J Ziegler; L Feng; N R Gonzalez; S Tateshima; R Jahan; N A Martin; F Viñuela; G R Duckwiler
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-12
Journal Detail:
Title:  AJNR. American journal of neuroradiology     Volume:  -     ISSN:  1936-959X     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003708     Medline TA:  AJNR Am J Neuroradiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Neurosurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Division of Interventional Neuroradiology and Department of Neurosurgery, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California; Division of Interventional Neuroradiology, University of California at Irvine, Orange, California; Division of Diagnostic and Interventional Neuroradiology, Naval Medical Center, San Diego, California; Kaiser Foundation Hospital, San Diego, California; and Department of Diagnostic Imaging, Kaiser Permanente Medical Center, Los Angeles, California.
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