Selective image-guided venous sinus exposure for direct embolization of dural arteriovenous fistula: technical case report.

Details

Serval ID
serval:BIB_EF2247903376
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Title
Selective image-guided venous sinus exposure for direct embolization of dural arteriovenous fistula: technical case report.
Journal
Surgical Neurology
Author(s)
Bruneau M., Lubicz B., Pirotte B., Taib N.O., Wikler D., Brotchi J., Levivier M.
ISSN
0090-3019 (Print)
ISSN-L
0090-3019
Publication state
Published
Issued date
2008
Peer-reviewed
Oui
Volume
69
Number
2
Pages
192-196; discussion 196
Language
english
Notes
Publication types: Case Reports ; Journal Article
Publication Status: ppublish
Abstract
BACKGROUND: Transcranial approaches for transsinusal endovascular therapy of DAVF have been sporadically reported by large craniectomies. Large craniectomies carry nevertheless a risk of postembolization extradural hematoma, reduced by delaying the endovascular procedure. We report a 1-session technique of SIGC for percutaneous transvenous DAVF embolization.
CASE DESCRIPTION: This 58-year-old woman developed a right-sided cerebellar hematoma in relation with a high-grade left transverse and sigmoid sinus DAVF. The DAVF was fed by branches from the left vertebral artery, left internal, and left external carotid arteries, draining into the transverse sinus with retrograde flow in cortical veins. Transvenous retrograde embolization was not feasible either through the left internal jugular vein because of thrombosis, or through the right one because of torcular septa. During the same anaesthetic session, a 5-cm-length selective craniectomy was shaped under magnetic resonance image guidance navigation according to the left transverse sinus with high-speed drill. Thereafter, back in the angiography room, the transverse sinus was taped and coiled resulting in a complete exclusion of the DAVF.
CONCLUSION: Selective image-guided craniectomy is efficient and safe for direct percutaneous transvenous embolization of DAVF in a single anesthetic session. Leaving bone beside the sinus prevents a parenchymal traumatic puncture. This bone has nevertheless to be drilled to allow an adequate sharp puncture angle. Doing so, postoperative hematoma is prevented by the small bone opening, the natural adherence of the dura matter and the possibility of direct compression.
Keywords
Central Nervous System Vascular Malformations/pathology, Central Nervous System Vascular Malformations/radiography, Craniotomy/methods, Embolization, Therapeutic/methods, Female, Humans, Middle Aged, Surgery, Computer-Assisted
Pubmed
Web of science
Create date
20/01/2008 17:35
Last modification date
20/08/2019 16:16
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