Ethmoidal Dural Arteriovenous Fistulae: An Assessment of Surgical and Endovascular Management

Ethmoidal Dural Arteriovenous Fistulae: An Assessment of Surgical and Endovascular Management AbstractOBJECTIVEEndovascular treatment of ethmoidal dural arteriovenous fistulae (DAVFs) has become technically feasible, but its relative risks and benefits have not justified its use. We present a series of patients with ethmoidal DAVFs treated almost exclusively with surgery at an institution where expert endovascular therapy was available. Surgical risks, treatment efficacy, and patient outcomes were determined for comparison with published endovascular data.METHODSSixteen patients with ethmoidal DAVFs were treated during a 17-year period from 1982 to 1999. In three patients, feeding arteries from the internal maxillary artery were embolized; no ophthalmic artery embolizations were performed. A low bifrontal surgical approach was used in most patients to expose, coagulate, and divide the fistulous site.RESULTSEthmoidal DAVFs were occluded grossly and angiographically in all 16 patients. There was no treatment-associated neurological morbidity, and clinical outcomes were good in all but one patient who was comatose initially.CONCLUSIONReview of our surgical experience with ethmoidal DAVFs as well as published endovascular results for these lesions suggests that endovascular management of ethmoidal DAVFs has a small but clinically significant risk to vision, is rarely effective in curing the fistula, and does not eliminate the need for surgery. In contrast, surgical management has no associated risk to vision, is highly effective at obliterating the fistula, and can contribute to good clinical outcomes in most patients. For these reasons, surgical management of ethmoidal DAVFs remains the treatment of choice. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Ethmoidal Dural Arteriovenous Fistulae: An Assessment of Surgical and Endovascular Management

Ethmoidal Dural Arteriovenous Fistulae: An Assessment of Surgical and Endovascular Management

C LIN IC A L STUDIES Ethmoidal Dural Arteriovenous Fistulae: An Assessment of Surgical and Endovascular Management Michael T. Lawton, M.D., Jay Chun, M.D., Ph.D., Charles B. Wilson, M.D., Van V. Halbach, M.D. Departments of Neurological Surgery (MTL, JC, CBW ) and Radiology (VVH), Neurointerventional Section, University of California, San Francisco, San Francisco, California OBJECTIVE: Endovascular treatm ent of ethmoidal dural arteriovenous fistulae (D A V Fs) has become technically feasible, but its relative risks and benefits have not justified its use. W e present a series of patients with ethmoidal DAVFs treated almost exclusively w ith surgery at an institution where expert endovascular therapy was available. Surgical risks, treatment efficacy, and patient outcomes were determined for comparison with published endovascular data. METHODS: Sixteen patients w ith ethm oidal D AVFs were treated during a 17-year period from 1982 to 1999. In three patients, feeding arteries from the internal maxillary artery were embolized; no ophthalm ic artery embolizations were performed. A low bifrontal surgical approach was used in most patients to expose, coagulate, and divide the fistulous site. RESULTS: Ethmoidal DAVFs w ere occluded grossly and angiographically in all 16 patients. There was no treatment- associated neurological m orbidity, and clinical outcomes were good in all but one patient who was comatose initially. CONCLUSION: Review of our surgical experience with ethmoidal DAVFs as w ell as published endovascular results for these lesions suggests that endovascular management of ethmoidal D AVFs has a small but clin ically significant risk to vision, is rarely effective in curing the fistula, and does not elim inate the need for surgery. In contrast, surgical management has no associated risk to vision, is highly effective at obliterating the fistula, and can contribute to good clinical outcomes in most patients. For these reasons, surgical management of...
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Publisher
Congress of Neurological Surgeons
Copyright
© Published by Oxford University Press.
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1097/00006123-199910000-00014
Publisher site
See Article on Publisher Site

Abstract

AbstractOBJECTIVEEndovascular treatment of ethmoidal dural arteriovenous fistulae (DAVFs) has become technically feasible, but its relative risks and benefits have not justified its use. We present a series of patients with ethmoidal DAVFs treated almost exclusively with surgery at an institution where expert endovascular therapy was available. Surgical risks, treatment efficacy, and patient outcomes were determined for comparison with published endovascular data.METHODSSixteen patients with ethmoidal DAVFs were treated during a 17-year period from 1982 to 1999. In three patients, feeding arteries from the internal maxillary artery were embolized; no ophthalmic artery embolizations were performed. A low bifrontal surgical approach was used in most patients to expose, coagulate, and divide the fistulous site.RESULTSEthmoidal DAVFs were occluded grossly and angiographically in all 16 patients. There was no treatment-associated neurological morbidity, and clinical outcomes were good in all but one patient who was comatose initially.CONCLUSIONReview of our surgical experience with ethmoidal DAVFs as well as published endovascular results for these lesions suggests that endovascular management of ethmoidal DAVFs has a small but clinically significant risk to vision, is rarely effective in curing the fistula, and does not eliminate the need for surgery. In contrast, surgical management has no associated risk to vision, is highly effective at obliterating the fistula, and can contribute to good clinical outcomes in most patients. For these reasons, surgical management of ethmoidal DAVFs remains the treatment of choice.

Journal

NeurosurgeryOxford University Press

Published: Oct 1, 1999

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