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Semin intervent Radiol 2003; 20(1): 027-042
DOI: 10.1055/s-2003-38106
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Intracranial Arteriovenous Fistulas: Approaches to Endovascular Treatment

Steven J. Willing
  • Associate Professor of Radiology, Interventional Neuroradiology, Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana
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Publication Date:
20 March 2003 (online)

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ABSTRACT

Arteriovenous fistulas of the head and neck include an assortment of conditions. Many, if not most, can be cured using a variety of endovascular techniques. Extracranial fistulas are usually traumatic in origin. Intracranial fistulas may be either traumatic or spontaneous and may be classified according to flow (high or low), pathology (direct or indirect), location, or patterns of supply and drainage. In this article we will focus on acquired intracranial arteriovenous fistulas and review the clinical presentation, classification schemes, history of treatment, and current approaches to treatment, focusing on endovascular approaches.

KEYWORDS

Carotid-cavernous fistula - dural arteriovenous fistula - embolization

REFERENCES

  • 1 Barrow D L, Spector R H, Braun I F. Classification and treatment of spontaneous carotid-cavernous sinus fistulas.  J Neurosurg . 1985;  62 248-256
    PubMedSearch in Google Scholar
  • 2 Hieshima G B, Cahan L D, Mehringer C M, Bentson J R. Spontaneous arteriovenous fistulas of cerebral vessels in association with fibromuscular dysplasia.  Neurosurgery . 1986;  18 454-458
    PubMedSearch in Google Scholar
  • 3 Numaguchi Y, Higashida R T, Abernathy J M, Pisarello J C. Balloon embolization in a carotid-cavernous fistula in fibromuscular dysplasia.  AJNR Am J Neuroradiol . 1987;  8 380-382
    PubMedSearch in Google Scholar
  • 4 Farley M K, Clark R D, Fallor M K, Geggel H S, Heckenlively J. Spontaneous carotid-cavernous fistula and the Ehlers-Danlos syndromes.  Ophthalmology . 1983;  90 1337-1342
    PubMedSearch in Google Scholar
  • 5 Halbach V V, Higashida R T, Dowd C F, Barnwell S L, Hieshima G B. Treatment of carotid-cavernous fistulas associated with Ehlers-Danlos syndrome.  Neurosurgery . 1990;  26 1021-1027
    CrossrefPubMedSearch in Google Scholar
  • 6 Kashiwagi S, Tsuchida E, Goto K. Balloon occlusion of a spontaneous carotid-cavernous fistula in Ehlers-Danlos syndrome type IV.  Surg Neurol . 1993;  39 187-190
    PubMedSearch in Google Scholar
  • 7 Barr J D, Mathis J M, Horton J A. Iatrogenic carotid-cavernous fistula occurring after embolization of a cavernous sinus meningioma.  AJNR Am J Neuroradiol . 1995;  16 483-485
    PubMedSearch in Google Scholar
  • 8 Phatouros C C, Halbach V V, Malek A M, Dowd C F, Higashida R T. Simultaneous subarachnoid hemorrhage and carotid cavernous fistula after rupture of a paraclinoid aneurysm during balloon-assisted coil embolization.  AJNR Am J Neuroradiol . 1999;  20 1100-1102
    PubMedSearch in Google Scholar
  • 9 Pedersen R A, Troost B T, Schramm V L. Carotid-cavernous sinus fistula after external ethmoid-sphenoid surgery. Clinical course and management.  Arch Otolaryngol . 1981;  107 307-309
    PubMedSearch in Google Scholar
  • 10 Feuerman T F, Hieshima G B, Bentson J R, Batzdorf U. Carotid-cavernous fistula following nasopharyngeal biopsy.  Arch Otolaryngol . 1984;  110 412-414
    PubMedSearch in Google Scholar
  • 11 Kuether T A, O'Neill O R, Nesbit G M, Barnwell S L. Direct carotid cavernous fistula after trigeminal balloon microcompression gangliolysis: case report.  Neurosurgery . 1996;  39 853-855
    PubMedSearch in Google Scholar
  • 12 Bizri A R, al-Ajam M, Zaytoun G, al-Kutoubi A. Direct carotid cavernous fistula after submucous resection of the nasal septum.  ORL J Otorhinolaryngol Relat Spec . 2000;  62 49-52
    PubMedSearch in Google Scholar
  • 13 Parkinson D, Downs A R, Whytehead L L, Syslak W B. Carotid cavernous fistula: direct repair with preservation of carotid.  Surgery . 1974;  76 882-829
    PubMedSearch in Google Scholar
  • 14 Serbinenko F A. Balloon catheterization and occlusion of major cerebral vessels.  J Neurosurg . 1974;  41 125-145
    CrossrefPubMedSearch in Google Scholar
  • 15 Debrun G, Lacour P, Caron J P. Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions.  J Neurosurg . 1978;  49 635-649
    CrossrefPubMedSearch in Google Scholar
  • 16 Norman D, Newton T H, Edwards M S, DeCaprio V. Carotid-cavernous fistula: closure with detachable silicone balloons.  Radiology . 1983;  149 149-157
    Search in Google Scholar
  • 17 Lewis A I, Tomsick T A, Tew Jr M J. Management of 100 consecutive direct carotid-cavernous fistulas: results of treatment with detachable balloons.  Neurosurgery . 1995;  36 239-244
    CrossrefPubMedSearch in Google Scholar
  • 18 Teng M M, Chang C Y, Chiang J H. Double-balloon technique for embolization of carotid cavernous fistulas.  AJNR Am J Neuroradiol . 2000;  21 1753-1756
    PubMedSearch in Google Scholar
  • 19 Siniluoto T, Seppanen S, Kuurne T. Transarterial embolization of a direct carotid cavernous fistula with Guglielmi detachable coils.  AJNR Am J Neuroradiol . 1997;  18 519-523
    PubMedSearch in Google Scholar
  • 20 Teng M M, Lirng J F, Chang T. Embolization of carotid cavernous fistula by means of direct puncture through the superior orbital fissure.  Radiology . 1995;  194 705-711
    PubMedSearch in Google Scholar
  • 21 Wessbecher F, Hartling R P, Nieves M, Eskridge J M. Treatment of carotid cavernous fistulas: a new balloon delivery system.  AJNR Am J Neuroradiol . 1992;  13 331-332
    PubMedSearch in Google Scholar
  • 22 Lewis A I, Tomsick T A, Tew Jr M J, Lawless M. Long-term results in direct carotid-cavernous fistulas after treatment with detachable balloons.  J Neurosurg . 1996;  84 400-404
    PubMedSearch in Google Scholar
  • 23 Chung T S, Lee J D, Suh J H, Kim D I, Park C Y. Increased cerebral perfusion after detachable balloon embolization of carotid cavernous fistula on technetium-99m-HMPAO brain SPECT.  J Nucl Med . 1993;  34 1987-1989
    PubMedSearch in Google Scholar
  • 24 Tsai F Y, Hieshima G B, Mehringer C M, Grinnell V, Pribram H. Delayed effects in the treatment of carotid-cavernous fistulas.  AJNR Am J Neuroradiol . 1983;  4 357-361
    PubMedSearch in Google Scholar
  • 25 McCormick W F, Kelly P J, Sarwar M. Fatal paradoxical muscle embolization in traumatic carotid-cavernous fistula repair. Case report.  J Neurosurg . 1976;  44 513-516
    PubMedSearch in Google Scholar
  • 26 Brodsky M C, Hoyt W F, Halbach V V. Recovery from total monocular blindness after balloon embolization of carotid-cavernous fistula.  Am J Ophthalmol . 1987;  104 86-87
    PubMedSearch in Google Scholar
  • 27 Halbach V V, Higashida R T, Hieshima G B, Norman D. Normal perfusion pressure breakthrough occurring during treatment of carotid and vertebral fistulas.  AJNR Am J Neuroradiol . 1987;  8 751-756
    PubMedSearch in Google Scholar
  • 28 Komiyama M, Yasui T, Yagura H, Fu Y, Nagata Y. Traumatic carotid-cavernous sinus fistula associated with an intradural pseudoaneurysm: a case report.  Surg Neurol . 1991;  36 126-132
    PubMedSearch in Google Scholar
  • 29 Cognard C, Gobin Y P, Pierot L. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.  Radiology . 1995;  194 671-680
    CrossrefPubMedSearch in Google Scholar
  • 30 Touho H, Ohnishi H, Komatsu T, Furuoka N, Karasawa J. Dural arteriovenous fistula caused by sinus thrombosis-case report.  Neurol Med Chir (Tokyo) . 1994;  34 543-546
    PubMedSearch in Google Scholar
  • 31 Chaudhary M Y, Sachdev V P, Cho S H. Dural arteriovenous malformation of the major venous sinuses: an acquired lesion.  AJNR Am J Neuroradiol . 1982;  3 13-19
    PubMedSearch in Google Scholar
  • 32 Mullan S. Reflections upon the nature and management of intracranial and intraspinal vascular malformations and fistulae.  J Neurosurg . 1994;  80 606-616
    PubMedSearch in Google Scholar
  • 33 Komiyama M, Nakajima H, Nishikawa M, Kan M. Traumatic carotid cavernous sinus fistula: serial angiographic studies from the day of trauma.  AJNR Am J Neuroradiol . 1998;  19 1641-1644
    PubMedSearch in Google Scholar
  • 34 Pierot L, Chiras J, Meder J F. Dural arteriovenous fistulas of the posterior fossa draining into subarachnoid veins.  AJNR Am J Neuroradiol . 1992;  13 315-323
    PubMedSearch in Google Scholar
  • 35 Vinuela F, Fox A J, Debrun G M, Peerless S J, Drake C G. Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases.  J Neurosurg . 1984;  60 976-984
    PubMedSearch in Google Scholar
  • 36 Halbach V V, Higashida R T, Hieshima G B. Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients.  Radiology . 1987;  163 443-447
    CrossrefPubMedSearch in Google Scholar
  • 37 Halbach V V, Higashida R T, Hieshima G B, Hardin C W, Pribram H. Transvenous embolization of dural fistulas involving the cavernous sinus.  AJNR Am J Neuroradiol . 1989;  10 377-383
    PubMedSearch in Google Scholar
  • 38 Halbach V V, Higashida R T, Hieshima G B, Mehringer C M, Hardin C W. Transvenous embolization of dural fistulas involving the transverse and sigmoid sinuses.  AJNR Am J Neuroradiol . 1989;  10 385-392
    PubMedSearch in Google Scholar
  • 39 Halbach V V, Higashida R T, Hieshima G B. Dural fistulas involving the cavernous sinus: results of treatment in 30 patients.  Radiology . 1987;  163 437-442
    CrossrefPubMedSearch in Google Scholar
  • 40 Monsein L H, Debrun G M, Miller N R, Nauta H J, Chazaly J R. Treatment of dural carotid-cavernous fistulas via the superior ophthalmic vein.  AJNR Am J Neuroradiol . 1991;  12 435-439
    PubMedSearch in Google Scholar
  • 41 Mironov A. Selective transvenous embolization of dural fistulas without occlusion of the dural sinus.  AJNR Am J Neuroradiol . 1998;  19 389-391
    PubMedSearch in Google Scholar
  • 42 Quinones D, Duckwiler G, Gobin P Y, Goldberg R A, Vinuela F. Embolization of dural cavernous fistulas via superior ophthalmic vein approach.  AJNR Am J Neuroradiol . 1997;  18 921-928
    PubMedSearch in Google Scholar
  • 43 Debrun G, Lacour P, Vinuela F. Treatment of 54 traumatic carotid-cavernous fistulas.  J Neurosurg . 1981;  55 678-692
    CrossrefPubMedSearch in Google Scholar
  • 44 Halbach V, Higashida R T, Hieshima G B, Hardin C W, Yang P J. Transvenous embolization of direct carotid cavernous fistulas.  AJNR Am J Neuroradiol . 1988;  9 741-747
    PubMedSearch in Google Scholar
  • 45 Komiyama M, Morikawa K, Fu Y. Indirect carotid-cavernous sinus fistula: transvenous embolization from the external jugular vein using a superior ophthalmic vein approach. A case report.  Surg Neurol . 1990;  33 57-63
    PubMedSearch in Google Scholar
  • 46 Jahan R, Gobin Y P, Glenn B, Duckwiler G R, Vinuela F. Transvenous embolization of a dural arteriovenous fistula of the cavernous sinus through the contralateral pterygoid plexus.  Neuroradiology . 1998;  40 189-193
    CrossrefPubMedSearch in Google Scholar
  • 47 Kuwayama N, Endo S, Kitabayashi M, Nishijima M, Takaku A. Surgical transvenous embolization of a cortically draining carotid cavernous fistula via a vein of the sylvian fissure.  AJNR Am J Neuroradiol . 1998;  19 1329-1332
    PubMedSearch in Google Scholar
  • 48 Collice M, D'Aliberti G, Arena O. Surgical treatment of intracranial dural arteriovenous fistulae: role of venous drainage.  Neurosurgery . 2000;  47 56-66
    CrossrefPubMedSearch in Google Scholar
  • 49 Guo W Y, Pan D H, Wu H M. Radiosurgery as a treatment alternative for dural arteriovenous fistulas of the cavernous sinus.  AJNR Am J Neuroradiol . 1998;  19 1081-1087
    PubMedSearch in Google Scholar
  • 50 Roy D, Raymond J. The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas.  Neurosurgery . 1997;  40 1133-1141
    CrossrefPubMedSearch in Google Scholar
  • 51 Yamashita K, Taki W, Nishi S. Transvenous embolization of dural caroticocavernous fistulae: technical considerations.  Neuroradiology . 1993;  35 475-479
    CrossrefPubMedSearch in Google Scholar
  • 52 Kuroda S, Ushikoshi S, Houkin K. Postoperative hyperperfusion in dural arteriovenous fistula associated with venous ischemia: case report.  Surg Neurol . 1998;  49 406-411
    PubMedSearch in Google Scholar
  • 53 Olteanu-Nerbe V, Uhl E, Steiger H J, Yousry T, Reulen H J. Dural arteriovenous fistulas including the transverse and sigmoid sinuses: results of treatment in 30 cases.  Acta Neurochir . 1997;  139 307-318
    CrossrefPubMedSearch in Google Scholar
  • 54 Urtasun F, Biondi A, Casaco A. Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization.  Radiology . 1996;  199 209-217
    PubMedSearch in Google Scholar
  • 55 Kurata A, Miyasaka Y, Kunii M. The value of long-term clinical follow-up for cases of spontaneous carotid cavernous fistula.  Acta Neurochir . 1998;  140 65-72
    Search in Google Scholar
  • 56 Zurin A A, Ushikoshi S, Houkin K,et al. Cerebral abscess as an unusual complication of coil embolization in a dural arteriovenous fistula. Case report.  J Neurosurg . 1997;  87 109-112
    CrossrefPubMedSearch in Google Scholar
  • 57 Phatouros C C, Higashida R T, Malek A M. Embolization of the meningohypophyseal trunk as a cause of diabetes insipidus.  AJNR Am J Neuroradiol . 1999;  20 1115-1118
    PubMedSearch in Google Scholar
  • 58 Friedman J A, Pollock B E, Nichols D A. Development of a cerebral arteriovenous malformation documented in an adult by serial angiography. Case report.  J Neurosurg . 2000;  93 1058-1061
    PubMedSearch in Google Scholar
  • 59 Komiyama M, Yamanaka K, Nagata Y, Ishikawa H. Dural carotid-cavernous sinus fistula and central retinal vein occlusion: a case report and a review of the literature.  Surg Neurol . 1990;  34 255-259
    PubMedSearch in Google Scholar
  • 60 Golnik K C, Newman S A, Ferguson R. Angle-closure glaucoma consequent to embolization of dural cavernous sinus fistula.  AJNR Am J Neuroradiol . 1991;  12 1074-1076
    PubMedSearch in Google Scholar
  • 61 Gupta N, Kikkawa D O, Levi L, Weinreb R N. Severe vision loss and neovascular glaucoma complicating superior ophthalmic vein approach to carotid-cavernous sinus fistula.  Am J Ophthalmol . 1997;  124 853-855
    PubMedSearch in Google Scholar
  • 62 Aihara N, Mase M, Yamada K. Deterioration of ocular motor dysfunction after transvenous embolization of dural arteriovenous fistula involving the cavernous sinus.  Acta Neurochir . 1999;  141 707-709
    CrossrefPubMedSearch in Google Scholar
  • 63 Kim A W, Kosmorsky G S. Arteriovenous communication in the orbit.  J Neuroophthal . 2000;  20 17-19
    PubMedSearch in Google Scholar
  • 64 Yoshimura S, Hashimoto N, Kazekawa K. Arteriovenous fistula around the ventriculoperitoneal shunt system in a patient with a dural arteriovenous malformation of the posterior fossa. Case report.  J Neurosurg . 1995;  82 288-290
    PubMedSearch in Google Scholar
  • 65 Kubota Y, Ueda T, Kaku Y, Sakai N. Development of a dural arteriovenous fistula around the jugular valve after transvenous embolization of cavernous dural arteriovenous fistula.  Surg Neurol . 1999;  51 174-176
    PubMedSearch in Google Scholar
  • 66 Glaser C, Krenn C G, Gruber A. Asystole during endovascular embolization of a dural arterio-venous fistula in the brain.  Anesth Analg . 1999;  89 1288-1289
    PubMedSearch in Google Scholar