Fellows’ Journal Club: Posterior Fossa Dural Arteriovenous Fistulas with Subarachnoid Venous Drainage: Outcomes of Endovascular Treatment

Fellows’ Journal Club

Twenty-six patients treated endovascularly for posterior fossa dural AVFs, type III, IV, or V, were included in this study. One hundred percent of the dural AVFs were occluded. A transarterial approach was performed in 23 dural AVFs; a combined transarterial and transvenous approach, in 2 dural AVFs; and a transvenous approach alone, in 1 dural AVF. The middle meningeal artery was the most common artery chosen to inject embolic liquid (12/26). Procedure-related morbidity was 15.4% at 24 hours, 7.7% at discharge, and 0% at 6 months. Procedure-related mortality was 0%. The authors conclude that endovascular treatment offers high occlusion rates for posterior fossa dural AVFs with low morbidity and mortality rates.

Abstract

BACKGROUND AND PURPOSE

Arteriography of a petrosal dAVF
Transvenous approach. Arteriography of a petrosal dAVF with petrosal outflow, fed by the recurrent tentorial branch of the infero-lateral trunk and a posterior meningeal branch, draining into the internal temporal vein.

Dural AVFs located in the posterior fossa are a rare entity. The objectives of the study were to analyze the anatomy of dural AVFs, their endovascular treatment strategies, and clinical outcomes.

MATERIALS AND METHODS

Two centers retrospectively selected patients treated between January 2009 and June 2018 having posterior fossa dural AVFs. We collected patient demographics, clinical presentation, arterial and venous outflow anatomy of the dural AVFs, and treatment outcomes.

RESULTS

Twenty-six patients treated endovascularly for posterior fossa dural AVFs, type III, IV, or V, were included. One hundred percent of the dural AVFs were occluded. A transarterial approach was performed in 23 dural AVFs (88.5%); a combined transarterial and transvenous approach, for 2 dural AVFs (7.7%); and a transvenous approach alone, for 1 dural AVF (3.8%). The middle meningeal artery was the most common artery chosen to inject embolic liquid (46%, 12/26). Procedure-related morbidity was 15.4% at 24 hours, 7.7% at discharge, and 0% at 6 months. Procedure-related mortality was 0%.

CONCLUSION

Endovascular treatment offers high occlusion rates for posterior fossa dural AVFs with low morbidity and mortality rates. The arterial approach is the first-line preferred approach, even if a transvenous or combined approach would be a safe and effective option for patients with favorable anatomy.

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Fellows’ Journal Club: Posterior Fossa Dural Arteriovenous Fistulas with Subarachnoid Venous Drainage: Outcomes of Endovascular Treatment
Jeffrey Ross
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