Embolization of dural arteriovenous fistula of anterior cranial fossa via sphenopalatine artery:a effect analysis / 中国脑血管病杂志

Objective To preliminarily discuss the safety and effectiveness of embolization of dural arteriovenous fistula of anterior cranial fossa via sphenopalatine artery. Methods From January 2002 to June 2017,the clinical data of 7 patients with dural arteriovenous fistula of anterior cranial fossa embolized via sphenopalatine artery at Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively.There were 6 men and 1 woman,their mean age was 60.4 ± 3.6 years.One patient had subarachnoid hemorrhage with hematoma,6 had non-specific symptoms. The technical methods and complications via sphenopalatine artery embolization were analyzed.The occlusion of the proximal drainage vein with the embolization agent was used as the standard for successful embolization.They were all clinically followed up at 6 months after procedure. Results (1)Five patients selected sphenopalatine artery as the preferred treatment.After embolization failed in other treatment approaches,2 patients were re-embolized via sphenopalatine artery. Five lesions were successfully embolized via sphenopalatine artery,including the sphenopalatine artery as the preferred treatment approach in 4 cases,the sphenopalatine artery as a remedial embolization approach after the failure of other arterial approaches in 1 case.Transsphenoidal artery failed to occlude the lesions in 2 cases,including successful embolization of other blood supply artery in 1 case during the operation,and postoperative angiography revealed that the lesion was almost completely occluded in the other 1.All patients recovered well without complications after procedure.(2)All patients were followed up for 6 months after procedure.The patients did not have blurred vision and other new neurological disorders, and they did not have new intracranial hemorrhage and nasal symptoms.Two of them underwent angiographic follow-up at admission.The immediate angiography in 1 patient showed that his lesion completely disappeared,At 6 months after operation,angiography revealed that the lesion was recurrence-free. The immediate angiography in 1 patient showed that his lesion nearly completely disappeared.At 4 months after operation, angiography revealed that the lesion disappeared completely. Conclusions Embolization of dural arteriovenous fistulas of anterior cranial fossa via sphenopalatine artery is a feasible,safe and effective treatment. It is also the treatment option after other poor arterial approach or failure of other arterial approach.

Surgical Management of Dural Arteriovenous Fistula of The Anterior Cranial Fossa: Case Report / 대한뇌혈관외과학회지

OBJECTIVE: A dural arteriovenous fistula (DAVF) of the anterior cranial fossa is rare. We report a case of a DAVF of the anterior cranial fossa which was treated surgically, following endovascular treatment failure. METHODS & RESULTS: The subject was a 53-year-old male with a headache caused by a hematoma in the right frontal lobe. A vascular abnormality of the anterior cranial fossa was suspected on brain computed tomographic angiography. The subsequent transfemoral cerebral angiography revealed that the AVF of the anterior cranial fossa was mainly fed by the left anterior ethmoidal artery. Endovascular therapy using N-butyl cyanoacrylate was attempted. However, the procedure failed to occlude the fistula due to the existing feeding artery (the right anterior ethmoidal artery). Consequently, a surgical approach was undertaken and the lesion was successfully obliterated. CONCLUSION: We report a rare case of an intracerebral hematoma caused by a DAVF, which was successfully managed surgically following, endovascular treatment failure.

Anterior Cranial Fossa Dural Arteriovenous Fistulae Presenting as Subdural Hematoma

Anterior cranial fossa dural arteriovenous fistulae (DAVFs) are very rare and the bleeding rate is very high, especially in the presence of leptomeningeal draining vein and aneurysmal varix formation. A 85-year-old male patient presented with subdural hematoma (SDH). Magnetic resonance image (MRI) and transfemoral carotid angiography (TFCA) disclosed DAVF at the anterior cranial fossa with bilateral arterial feeders and leptomeningeal draining vein with varix formation. The lesion was treated by simple ligation of pial connecting vein using low frontal craniotomy. In comparison with DAVFs of the other sites, the anterior cranial fossa DAVF is difficult to manage by endovascular treatment due to not only the difficulty of transvenous access but the risk of visual impairment when using transarterial route. Surgical ligation of pial connecting vein is feasible and effective treatment.

Surgical Management of Dural Arteriovenous Fistula of the Anterior Cranial Fossa after Failure of Embolization Therapy: Case Report

Dural arteriovenous fistula (DAVF) of anterior cranial fossa is a rare entity. The authors report a 57 year-old man presented with retro-orbital headache caused by a large hematoma in the right frontal lobe. Angiography demonstrated a DAVF of anterior cranial fossa fed by branches of middle meningeal and anterior ethmoidal artery. Endovascular therapy using N-butyl cyanoacrylate was tried, however, was failed to occlude the fistula. After than, the lesion was successfully obliterated by surgical means. The therapeutic roles and pitfalls of endovascular treatment and surgical treatment for the anterior fossa DAVF are discussed.

Dural Arteriovenous Malformation on the Anterior Cranial Fossa

Dural arteriovenous malformations(AVM) are not uncommon. Reports of intracranial dural AVM have been increasing but most of them deal with dural AVM in the region of the cavernous sinus, posterior fossa and tentorium, but those of the anterior cranial fossa are very rare. Recently, we experienced two cases of right frontal dural arteriovenous malformation fed mainly by both ethmoidal arteries. The angiographic appearance in these two cases is quite uniform. The nidus was located in the frontal dura, although their main feeders were dural arteries. They were drained through an intracerebral cortical vein associated with aneurysmal dilatation of proximal portion into superior sagittal sinus. Spontaneous intracerebral hematoma was the cause of the clinical symptoms. We report two cases of intracerebral hematoma, caused by dural AVM, which was successfully managed by surgical treatment.

Patterns of the spheno – ethmoidal and fronto – ethmoidal sutures in the anterior cranial fossa in Thais.

Ninety – six dry, adult Thai skulls, 50 males and 46 females, were studied for patterns of sphenoethmoidal and fronto – ethmoidal sutures. In all of the skulls, the posterior border of the cribriform plates of ethmoid bones articulated with the anterior margin of ethmoidal spine and the posterior border of orbital plate of the frontal bone articulated with the anterior border of the lesser wing of the sphenoid bone. The distribution of the patterns was divided into 5 types according to the shape of the ethmoidal spine and the various forms of suture. In type I (29%), rthmoidal spine was triangular in shape and projected forward in the medium from the jugum sphenoidale to articulate with the back of back of the cribrifrom plate. In type II (25%), the area of the sphenoid was reduced by the right and left retro – ethmoidal processes of the frontal so that ethmoidal spine had a quadrilateral extension joining it to the jugum sphenoidale. In type III (29%), the sphenoidal area was further reduced so that the ethmoidal spine appeared to have developed a constricted neck. In type IV (14%), the ethmoidal spine was triangular in shape but did not take a part of jugum sphenoidale. It articulated along a transverse line directly with the jugum sphenoidale. Finally, in type V (3%), the ethmoidal spine did not articulate with the jugum sphenoidale because of the meeting retro – ethmoidal processes of the frontal bone. The distribution of the various types was not significally different in sex but significally different in race.

AN APPLIED MORPHOMETRIC STUDY OF THE ANTERIOR CRANIAL FOSSA / 解剖学报

The morphometric value of the anterior cranial fossa has previously been poorly documented. There is also an absence of information about the asymmetry between the two halves of this fossa. In a series of 100 Chinese adult cranial bases at random, distances from each selected osseous point to a particular plane or distances between osseous points were measured, All these points, except the frontozygomatic point only, are endocranially situated, and data on 17 variables were available for statistical analysis. As a result, the right half shows some greater sagittal values than that of the left, and the width from the frontozygomatic point to the median sagittal plane is greater on the right half than that on the left, the differences are statistically significant or highly significant. Moreover, more of the sagittal measurements on the right side Correlate significantly with the right-left measurements. Accordingly, the two halves of the anterior cranial fossa is asymmetrically designed. Problems relating to the line of demarcation between the median portion of the anterior and middle cranial fossae, as well as the possible eraniocerebrum relationship and clinical considerations are discussed.