dural arteriovenous fistulae static or dynamic? cognard et al –seven patients with documented...
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Dural Arteriovenous Fistulae Static or Dynamic?
• Cognard et al– seven patients with documented worsening of
venous drainage– aggressive natural history
Neuroradiology 39:59, 1997
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Dural AVFsExperimental Investigation
Common carotid/external jugular anstamosis
Dural AVFs only with sinus thrombosis
J Neurosurg 80:884, 1994
J Neurosurg 83:539, 1995
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Dural AVFsExperimental Investigation
Dural AVFs with sinus thrombosis and venous hypertension
Correlation with angiogenesis index
Implied role in pathogenesis of vascular growth factors (VEGF)
J Neurosurg 87:267, 1997
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Dural Arteriovenous Fistulae Etiology
Arteriovenous malformation affecting the transverse dural venous sinus - an aquired lesion
Houser et al. Mayo Clin Proc 54:651, 1979
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Dural Arteriovenous Fistulae Embolization
Transarterial and/or Transvenous
Symptom palliation
Angiographic cure
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Transvenous Embolization
Venous access
Indication for therapy
24 patients
4% perm morbidity
96% clinical cureRoy & Raymond Neurosurgery 40:1133, 1997
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Dural Arteriovenous Fistulae Surgical Options
• resection
• packing• Endo et al J Neurosurg 88:449, 1998
• disconnection• Collice et al J Neurosurg 84:810, 1996
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Surgical Disconnection:Work in Progress
• Norris J et al• 1988- present, 141 patients with dural AVFs• Surgical disconnection
– 35 Borden Grade III, 12 Borden Grade II
• All grade III patients disconnected had angiographic cure
• All Grade II lesions converted to Grade I with stable clinical follow-up
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Dural Arteriovenous Fistulae:Radiation?
• case reports
• biological target
• target size eg thickness
• indication for therapy– time to cure vs natural history
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Cavernous Malformations