Intracranial and Spinal Dural Arteriovenous Fistulas

Preface
Acknowledgements
About the Book
Contents
About the Editor
1: Classifications of Cranial and Spinal Dural Arteriovenous Fistulas and Their Endovascular Embolization
	1.1	 Introduction
	1.2	 Zipfel Classification of  DAVFs [13]
	1.3	 Endovascular Approaches
	1.4	 Transarterial Embolization
		1.4.1	 nBCA
		1.4.2	 Onyx
		1.4.3	 PHIL and Squid
	1.5	 Transvenous Approach
	1.6	 Stereotactic Radiosurgery
	1.7	 Surgery
	1.8	 Endovascular Management Based on Zipfel Classification of DAVFs [13]
	1.9	 Conclusions
	References
2: Pediatric Intracranial Dural Arteriovenous Fistulas: Review of the Literature and Case Report
	2.1	 Introduction
	2.2	 Pediatric dAVF Classification
		2.2.1	 Dural Sinus Malformation
		2.2.2	 Infantile dAVFs
		2.2.3	 Adult-Type dAVFs
		2.2.4	 Other Classifications
	2.3	 Pathogenesis
	2.4	 Natural History
	2.5	 Clinical Manifestations
		2.5.1	 Symptoms of High-Flow Arteriovenous Shunts
			2.5.1.1	 Pediatric DSM with dAVF
			2.5.1.2	 Infantile dAVF
		2.5.2	 Symptoms from Retrograde Venous Drainage
		2.5.3	 Symptoms of Cavernous Sinus Involvement
		2.5.4	 Other Symptoms
	2.6	 Diagnostics
	2.7	 Treatment
		2.7.1	 Endovascular Treatment
	2.8	 Conclusion
	References
3: Pediatric Dural Arteriovenous Shunts
	3.1	 Introduction
	3.2	 Classification and Description of Arteriovenous Shunts
	3.3	 Angiographic characteristics
	3.4	 Treatment
	3.5	 Predictors of Poor Neurological Outcome
	3.6	 Dural Sinus Malformations
	3.7	 Infantile Dural Arteriovenous Shunts
	3.8	 Adult-Type Dural Arteriovenous Shunts
	3.9	 Conclusion
	References
4: A Small Tentorial Dural Arteriovenous Fistula with a Venous Aneurysm in the Pons Mimicking a Cavernous Angioma
	4.1	 Introduction
	4.2	 Case Presentation
	4.3	 Discussion
	4.4	 Conclusion
	References
5: Endovascular Treatment for Traumatic Internal Carotid Cavernous Fistula: Current Difficulties and Solutions
	5.1	 Introduction
	5.2	 Angioarchitecture of TICCF
		5.2.1	 Feeding Artery
		5.2.2	 CS State and Fistula
		5.2.3	 Draining Path
		5.2.4	 Relationship Between Symptoms and Venous Drainage
	5.3	 EVT Principle and Choices
	5.4	 Transarterial EVT Technique
		5.4.1	 Reconstructive with Detachable Balloon or Coils
		5.4.2	 Reconstructive with Covered Stent and FD
			5.4.2.1	 Covered Stent
			5.4.2.2	 Flow Diversion
		5.4.3	 Deconstruction with ICA Trapping
	5.5	 Transvenous or Combined Transarterial EVT Techniques
	5.6	 Special Types of TICCF
		5.6.1	 Bilateral TICCFs
		5.6.2	 Recurrent TICCF
	5.7	 Complications
		5.7.1	 Technique Complication
		5.7.2	 Cranial Nerve Palsy
		5.7.3	 Ischemic Complication
		5.7.4	 Trigeminocardiac Reflex
	5.8	 Prognosis
	5.9	 Summary
	References
6: Angioarchitecture of Dural Arteriovenous Fistula
	6.1	 Introduction
	6.2	 Understanding dAVF Angioarchitecture from a Pathogenetic Point of View
		6.2.1	 The Dural Venous Sinus “Compartment” as the Site of the Fistula
		6.2.2	 Parallel Venous Channel
		6.2.3	 The Common Arterial Collector
	6.3	 Classification Schemes That Detail Venous Aspects of the Angioarchitecture of dAVF
	6.4	 Location-Specific Angioarchitecture
	6.5	 Summary
	References
7: The Clinical Value of SWI in Dural Arteriovenous Fistula: Detection of Extensive Parenchymal Pathology
	7.1	 Case Report
	7.2	 Discussion
	7.3	 Conclusion
	References
8: Transvenous Embolization of Dural Arteriovenous Fistulas
	8.1	 Introduction
	8.2	 Transvenous Methods
	8.3	 Selection of Embolic Materials
	8.4	 Carotid-Cavernous Fistulas (CCFs)
	8.5	 Transverse-Sigmoid Sinus DAVFs
	8.6	 Tentorial DAVFs
	8.7	 Superior Sagittal Sinus DAVFs
	8.8	 Anterior Cranial Fossa DAVFs
	8.9	 Other DAVFs
	8.10	 Conclusions
	References
9: Dural Carotid-Cavernous Fistula Treatment
	9.1	 Introduction
	9.2	 Cavernous Sinus Anatomy
	9.3	 Arterial Supply to a dCCF
	9.4	 Endovascular Treatment of a dCCF
	9.5	 Transvenous Access
		9.5.1	 Inferior Petrosal Sinus Approach
			9.5.1.1	 Ipsilateral IPS Approach
			9.5.1.2	 Contralateral IPS Approach
			9.5.1.3	 Approach for Bilateral Dural CCFs
		9.5.2	 Facial Vein Approach
		9.5.3	 Superficial and Middle Temporal Vein Approach
		9.5.4	 Superior Petrosal Sinus (SPS) Approach
		9.5.5	 Direct SOV Puncture
		9.5.6	 Transarterial Access
		9.5.7	 Open Surgery
	9.6	 Complications of Endovascular Embolization
	9.7	 Conclusion
	References
10: Cavernous Dural Arteriovenous Fistulas: Transorbital Cavernous Sinus Direct Puncture
	10.1	 Introduction
	10.2	 Anatomy
		10.2.1	 Venous Connections
		10.2.2	 Cranial Nerves, Optic Canal and Orbital Fissures
	10.3	 Classification
	10.4	 Clinical Manifestations
	10.5	 Diagnosis
	10.6	 Treatment
		10.6.1	 Treatment Options
		10.6.2	 Endovascular Treatment: Results and Limitations
		10.6.3	 Alternative Approaches
		10.6.4	 Cavernous Sinus Direct Puncture: Technique
			10.6.4.1	 Inferolateral Access
			10.6.4.2	 Superomedial Access
	10.7	 Conclusion
	References
11: Cranial Dural Arteriovenous Fistulas: The Role of Transarterial and Transvenous Balloon-Assisted Embolization
	11.1	 Introduction
	11.2	 Pros and Cons of Transarterial and Transvenous Approaches
		11.2.1	 Transarterial Approach
		11.2.2	 Transvenous Approach
	11.3	 Dural Sinus Sacrifice Versus Dural Sinus Preservation
	11.4	 Specific Challenges While Treating DAVFs
		11.4.1	 DAVFs with Direct Leptomeningeal Venous Drainage
		11.4.2	 DAVFs Draining to a Dural Sinus
	11.5	 Rationale for the Use of Balloon Catheters in DAVF Treatment
		11.5.1	 Transarterial Double-Lumen Balloon
		11.5.2	 Transvenous “Protective” Balloon
	11.6	 Technical Nuances for the Use of Transarterial and Transvenous Balloon Catheters
		11.6.1	 DAVFs with Direct Leptomeningeal Venous Drainage
		11.6.2	 DAVFs Draining to a Dural Sinus
	11.7	 Results of the Balloon-Assisted Treatment of DAVFs
		11.7.1	 Transarterial Double-Lumen Balloon Catheter
		11.7.2	 Transvenous “Protection” Balloon Catheter
	11.8	 Perspectives
	11.9	 Conclusion
	References
12: Tentorial Dural Arteriovenous Fistulas: Anatomy, Clinical Presentation and Endovascular Treatment
	12.1	 Introduction
	12.2	 Epidemiology
	12.3	 Anatomical Considerations
	12.4	 Vascular Supply
	12.5	 Venous Drainage
	12.6	 Clinical Presentation
	12.7	 Classification
	12.8	 Treatment
		12.8.1	 Microsurgical Treatment
		12.8.2	 Endovascular Treatment
			12.8.2.1	 Transvenous Approach
			12.8.2.2	 Transarterial Approach
		12.8.3	 Endovascular Treatment Results
		12.8.4	 Importance of the Preferential Use of the Middle Meningeal Artery
		12.8.5	 Middle Meningeal Artery Limitations
		12.8.6	 Use of an Alternative Arterial Access
		12.8.7	 Transvenous and Combined Approaches
		12.8.8	 Nonadhesive Liquids as the Preferred Embolic Agent
		12.8.9	 Influence of the Number of Arterial Feeders
		12.8.10 Clinical Outcomes
		12.8.11 Complications
		12.8.12 Cranial Nerve Deficits After Arterial Embolization
		12.8.13 Middle Meningeal Artery
		12.8.14 Medial Tentorial Artery
		12.8.15 Distal Onyx Migration
		12.8.16 Hemorrhage
	12.9	 Conclusions
	References
13: Structural Analysis of Tentorial Dural Arteriovenous Fistulae with Special Considerations of Venous Ectasia: Proposing a Simpler Classification
	13.1	 Introduction
	13.2	 Clinical Presentations
	13.3	 Summary of Previously Reported Classifications: Anatomy of a Tentorium Cerebelli and TdAVF
	13.4	 Our Data
		13.4.1	 Materials and Methods
		13.4.2	 Results
		13.4.3	 Case Presentations
		13.4.4	 Discussion
	13.5	 The BVs and the EVs
		13.5.1	 BV
		13.5.2	 BV Related to TdAVF
			13.5.2.1	 Superior Tentorial BVs
			13.5.2.2	 Petrosal BVs or Anterior Metencephalic Group
			13.5.2.3	 Falcine BVs
			13.5.2.4	 Galenic or Superior Group of the Posterior Fossa
			13.5.2.5	 Inferior Tentorial BVs or Dorsal Metencephalic Group
		13.5.3	 EVs
	13.6	 Concept of “Directness, Exclusiveness, and Strain” [65]
		13.6.1	 General Considerations
	13.7	 Conclusions
		13.7.1	 Locations of the Shunt of TdAVF
	References
14: Dural Arteriovenous Fistula in Moyamoya Angiopathy
	14.1	 Introduction
	14.2	 Pathophysiology
	14.3	 Management
	14.4	 Conclusion
	References
15: Spinal Dural Arteriovenous Shunts
	15.1	 Introduction
	15.2	 Classification of the SDAVSs (Fig. 15.1, Tables 15.1 and 15.2) [1, 2]
	15.3	 Natural History and Age Onset, Clinical Presentation Corresponding to Each Type of Classification [2, 6, 12]
		15.3.1	 Spinal SDAVS
		15.3.2	 Pathology: Clinical Presentation
		15.3.3	 SDAVS: Pathophysiology
	15.4	 Treatment Options: Need Full Information from Imaging Findings
		15.4.1	 SDAVS: Treatment Indications [6, 8, 11]
		15.4.2	 SDAVS: Endovascular Treatment [1, 3, 6, 8, 13]
		15.4.3	 SDAVS: Treatment Surgery
	15.5	 Imaging of Spinal DAVS
		15.5.1	 MRI Imaging of Spinal DAVS (Fig. 15.3) [1, 6–8]
		15.5.2	 Current Imaging Protocol [1, 4, 6, 7, 9, 14, 15]
		15.5.3	 Special Consideration in Pediatric Spinal Arteriovenous Shunts
		15.5.4	 Differential Diagnosis
			15.5.4.1	 Spinal Dural Arteriovenous Shunts
	15.6	 Spinal Vascular Anatomy and Imaging (Figs. 15.20, 15.21 and 15.22) [1, 4, 7, 9, 15]
		15.6.1	 Routine Protocol in the Work-Up of the Spinal AV Shunt in the Spinal Angiogram (Figs. 15.23, 15.24, 15.25, 15.26 and 15.27)
		15.6.2	 Technique: ±Under GA
	15.7	 Follow Up Imaging of Spinal Vascular Lesions
		15.7.1	 Recurrence Symptoms After Endovascular Treatment
	References
16: Intraoperative Imaging Techniques in the Surgical Management of Spinal AV Fistulas
	16.1	 Introduction, Diagnosis and Treatment
		16.1.1	 Introduction
		16.1.2	 Diagnosis
		16.1.3	 Treatment
	16.2	 Intraoperative Imaging Techniques
		16.2.1	 Indocyanine Green Videoangiography (ICGVA)
		16.2.2	 Intraoperative Ultrasound (ioUS)
		16.2.3	 Sodium Fluorescein
	16.3	 Conclusions
	References
17: Embolization of Spinal Dural Arteriovenous Fistulae Using a Nonadhesive Liquid Embolic Agent Delivered Via a Dual-Lumen Balloon Catheter
	17.1	 Spinal Vascular Anatomy
	17.2	 Pathophysiology
	17.3	 Diagnostic Angiography
	17.4	 Management
	17.5	 NLEAs
	17.6	 Dual-Lumen Balloon Catheters
	17.7	 Embolization Using a Dual-Lumen Balloon
	17.8	 Dual-Lumen Balloon Catheter Use to Treat an SDAVF
	17.9	 Follow-Up
	17.10	 Conclusion
	References
18: Predicting Outcomes of Stereotactic Radiosurgery for Dural Arteriovenous Fistulas
	18.1	 Chapter Overview
	18.2	 Current Grading Scales
	18.3	 Predictors of Obliteration
		18.3.1	 Anatomy
		18.3.2	 Physiology
		18.3.3	 Clinical Characteristics
	18.4	 Predictors of Adverse Events
		18.4.1	 Anatomy
		18.4.2	 Physiology
		18.4.3	 Clinical Characteristics
	18.5	 Next Steps
	References
19: Complications During Endovascular Embolization of Dural Arteriovenous Fistulas
	19.1	 Introduction
	19.2	 Trigeminal Cardiac Reflex
	19.3	 Cranial Nerves Palsy
	19.4	 Cerebral Infarction
	19.5	 Venous Infarction and Venous Bleeding
	19.6	 Vessel Perforation
	19.7	 Cardiac and Pulmonary Embolism
	19.8	 Retained Microcatheter
	19.9	 Intracranial Abscess
	19.10	 Conclusion
	References
20: Hemorrhagic Complications After Endovascular Treatment for Intracranial Dural Arteriovenous Fistulas
	20.1	 Introduction
	20.2	 Classification of EVT-Associated Hemorrhage
	20.3	 Angioarchitecture of EVT-Associated Hemorrhage
		20.3.1	 Feeding Artery
		20.3.2	 Fistula Structure
		20.3.3	 Draining Vein
	20.4	 EVT Techniques, Risks, and Preventive Measures
		20.4.1	 General Considerations
		20.4.2	 TAE, Risks and Preventive Measures
		20.4.3	 TVE, Its Risks, and Preventive Measures
			20.4.3.1	 Sinus Trapping
			20.4.3.2	 Sinus Preservation by Retrograde Catheterization
		20.4.4	 Combination of TAE and TVE with Balloon Protection
	20.5	 Treatment and Prognosis of Hemorrhagic Complications
	20.6	 Summary
	References