ABSTRACT
INTRODUCTION: Ethmoidal dural arteriovenous fistulas (eDAVFs) are an unusual type of intracranial vascular lesion that commonly present with acute haemorrhage. AIM: We presented 3 cases of ethmoidal DAVFs treated effectively by endovascular embolization with Onyx. RESULTS: 3 patients hospitalized by reasons of stroke (2 cases) and vision impairment of the right eye (1 case). The digital subtraction angiography (DSA) showed the fistulas supplied by ethmoidal branches of the ophthalmic arteries (3 cases) and an additional supply from the ethmoidal branches of the internal maxillary artery (1 case). The cortical venous drainage was dilated and flowed to the superior sagittal sinus. The superselective microcatheterization through the ophthalmic artery allowed injection of Onyx sufficient plug around the distal end of the catheter without any complications. CONCLUSION: eDAVFs with neurologic complications could be treated effectively by endovascular embolization with Onyx.
Subject(s)
Arteriovenous Fistula/therapy , Dimethyl Sulfoxide/therapeutic use , Embolization, Therapeutic/methods , Intracranial Arteriovenous Malformations/therapy , Ophthalmic Artery/diagnostic imaging , Polyvinyls/therapeutic use , Aged , Arteriovenous Fistula/diagnostic imaging , Central Nervous System Vascular Malformations/diagnostic imaging , Central Nervous System Vascular Malformations/therapy , Cerebral Angiography , Cerebral Veins/diagnostic imaging , Computed Tomography Angiography , Female , Humans , Intracranial Arteriovenous Malformations/diagnostic imaging , Magnetic Resonance Angiography , Male , Meningeal Arteries/diagnostic imaging , Middle Aged , Superior Sagittal Sinus/diagnostic imagingABSTRACT
BACKGROUND AND PURPOSE: Prediction of intracranial aneurysm growth risk can assist physicians in planning of follow-up imaging of conservatively managed unruptured intracranial aneurysms. We therefore aimed to externally validate the ELAPSS (Earlier subarachnoid hemorrhage, aneurysm Location, Age, Population, aneurysm Size and Shape) score for prediction of the risk of unruptured intracranial aneurysm growth. METHODS: From 11 international cohorts of patients ≥18 years with ≥1 unruptured intracranial aneurysm and ≥6 months of radiological follow-up, we collected data on the predictors of the ELAPSS score, and calculated 3- and 5-year absolute growth risks according to the score. Model performance was assessed in terms of calibration (predicted versus observed risk) and discrimination (c-statistic). RESULTS: We included 1,072 patients with a total of 1,452 aneurysms. During 4,268 aneurysm-years of follow-up, 199 (14%) aneurysms enlarged. Calibration was comparable to that of the development cohort with the overall observed risks within the range of the expected risks. The c-statistic was 0.69 (95% confidence interval [CI], 0.64 to 0.73) at 3 years, compared to 0.72 (95% CI, 0.68 to 0.76) in the development cohort. At 5 years, the c-statistic was 0.68 (95% CI, 0.64 to 0.72), compared to 0.72 (95% CI, 0.68 to 0.75) in the development cohort. CONCLUSIONS: The ELAPSS score showed accurate calibration for 3- and 5-year risks of aneurysm growth and modest discrimination in our external validation cohort. This indicates that the score is externally valid and could assist patients and physicians in predicting growth of unruptured intracranial aneurysms and plan follow-up imaging accordingly.
