M. Erdem YILDIZ, Selçuk PEKER, Olcay ÇİZMELİ, M. Necmettin PAMİR

Dural Arteriovenöz Fistül DAVF Tedavisinde Kombine Yaklaşım: Süperselektif Embolizasyon ve Gamma Knife Radyocerrahisi

Dural arteriovenöz fistüller DAVF dural arterler ve venler veya sinüsler arasındaki anormal vasküler bağlantılardan oluşan lezyonlardır. Çok sayıda fistül içerebilmeleri ve venöz drenaj paternlerindeki değişiklikler tedavi kararında güçlüklere neden olabilmektedir. Biz bu yazıda sol eksternal karotid arterin orta meningeal ve oksipital dallarından dolan, önce süperselektif olarak embolize edilen ve 3 ay sonraki kontrolde oksipital besleyicilerinin rekanalize olduğu gözlenen DAVF’ li olguya ikinci kez uyguladığımız kombine süperselektif embolizasyon artı Gamma Knife tedavisini sunmaktayız

Combined Treatment Approach To Dural Arteriovenous Fistulae Davf : Superselective Embolization and Gamma Knife Radiosurgery

Dural arteriovenous fistulae DAVF are abnormal connections between the branches of dural arteries and dural veins or venous sinuses. They may consist of numerous fistulous connections, and venous drainage patterns show variations which make the treatment strategy difficult. We present a case of DAVF with feeding vessels from the middle meningeal and occipital branches of the left external carotid artery, treated primarily by superselective embolization and upon recanalization of the occipital feeders within three months, Gamma Knife was applied and subsequent embolization was performed for the second time

Keywords:

dural arteriovenous fistulae, embolization, gamma knife,

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Cognard C, Gobin YP, Pierot L, et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a rewised classification of venous drainage. Radiology 1995;194:671-680.

Lasjaunias P, Berenstein A. Surgical neuroangiography. Dural arteriovenous shunts. 2nd edition. Germany: Springer-Verlag Publications; 2004: 565-607.

Brown RD, Weibers DO, Nichols DA. Intracranial dural arteriovenous fistulae: angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients. J Neurosurg 1994;81:571-538.

Awad IA, Little RJ, Akarawi WP, Ahl J. Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 1990;72:839-850.

Satomi J, van Dijk JM, Terbrugge K, Willinsky RA, Wallace MC. Benign cranial dural arteriovenous fistulas: Outcome of conservative management based on the natural history of the lesion. J Neurosurg 2002;97:767-770.

Gupta AK, Periarkaruppan AL. Intracranial dural arteriovenous fistulas: A review. Indian J Radiol Imaging 2009;19:43-48.

Kyosue Hori Y, Okahara M, et al. Treatment of intracranial dural arteriovenous fistulas: current strategies based on location and hemodynamics, and alternative techniques of transcatheter embolization. Radiographics 2004;24:1637-1653.

Lasjaunias P, Chiu M, TerBrugge K, Tolia A, Hurth M, Bernstein M. Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 1986;64:724-730.

Iwama T, Hashimoto N, Takagi Y, Tanaka M, Yamamoto S, Nishi S, et al. Haemodynamic and metabolic disturbances in patients with intracranial dural arteriovenous fistulas: Positron emission tomography evaluation before and after treatment. J Neurosurg 1997;86:806-811.

Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid cavernous sinus fistulas. J Neurosurg 1985;62:248-256.

Dawson RC, III, Joseph GJ, Owens DS, Barrow DL. Transvenous embolization as the primary therapy for arteriovenous fistulas of the lateral and sigmoid sinuses. AJNR Am J Neuroradiol 1998; 19:571-576.

Urtasun F, Biondi A, Casaco A, et al. Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization. Radiology 1996; 199:209-217.

Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 1995; 82:166-179.

Roy D, Raymond J. The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 1997; 40:1133- 1144.

Oishi H, Arai H, Sato K, Iizuka Y. Complications associated with transvenous embolization of cavernous dural arteriovenous fistula. Acta Neurochir (Wien) 1999; 141:1265-1271.

Lawton MT, Chun J, Wilson CB, Halbach VV. Ethmoidal dural arteriovenous fistulae: an assessment of surgical and endovascular management. Neurosurgery 1999; 45:805-811.

Kawaguchi S, Sakaki T, Morimoto T, Hoshida T, Nakase H. Surgery for dural arteriovenous fistula in superior sagittal sinus and transverse sinus. J Clin Neurosci 2000; 7:47-49.

Friedman JA, Pollock BE, Nichols DA, Gorman DA, Foote RL, Staford SL. Results of combined stereotactic radiosurgery and transarterial embolization for dural arteriovenous fistulas of the transverse and sigmoid sinuses. J Neurosurg. 2001; 94(6):886–891.

Pan DH, Chung WY, Guo WY, Wu HM, Liu KD, Shiau CY, Wang LW. Stereotactic radiosurgery for the treatment of dural arteriovenous fistulas involving the transverse-sigmoid sinus. J Neurosurg. 2002; 96(5):823–829.

Koebbe CJ, Singhal D, Sheehan J, Flickinger JC, Horowitz M, Kondziolka D, Lunsford DL. Radiosurgery for dural arteriovenous fistulas. Surg Neurol. 2005; 64(5):392–399.