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Middle cranial fossa non-cavernous sinus dural arteriovenous fistulas: 20 years of experience

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Abstract

Non-cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) involving the sphenoid bone are rare entities that are easily confused with one another due to the complex structure and high variability of the venous system around the middle cranial fossa. We present a large retrospective study on middle cranial fossa non-CS DAVFs and review the literature on DAVF treatment in this location as well as relative anatomy. 15 patients had DAVFs involving the lesser sphenoid wing and 11 patients had DAVFs involving the greater sphenoid wing. Six patients presented with intracranial hemorrhage or subarachnoid hemorrhage (23.1%, 6/26). The most common symptoms were eye symptoms (38.5%, 10/26). Nineteen patients were treated with trans-arterial embolization (TAE) using liquid embolic agents and two patients were treated with transvenous embolization (TVE) using Onyx or in combination with coils. Surgical disconnection of the drainage veins was performed in five patients, with three cases experiencing unsuccessful TAE. Anatomic cure was achieved in 92.3% of the patients (24/26). Twelve patients had DSA and clinical follow-up from 3 to 27 months. There was one recurrence (8.3%) of the fistula in the patient two months after the initial complete occlusion. The majority of patients can be cured endovascularly. Laterocavernous sinus DAVFs may not be embolized by transvenous approach via the cavernous sinus because there is often no connection between them in most patients. A small percentage of patients may require surgical ligation to be cured.

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Data availability

Data are available upon reasonable request.

Abbreviations

CS:

Cavernous sinus

DAVF:

Dural arteriovenous fistula

DSA:

Digital subtraction angiography

IQR:

Interquartile range

LCS:

Laterocavernous sinus

MMA:

Middle meningeal artery

MRA:

Magnetic resonance angiography

mRS:

Modified Ranking score

SMCV:

Superficial middle cerebral vein

SPS:

Sphenoparietal sinus

TAE:

Transarterial embolization

TVE:

Transvenous embolization

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Funding

This study was funded by the National Natural Science Foundation of China (No. 82101460).

Author information

Author notes

  1. Yongjie Ma, Hongqi Zhang & Peng Zhang

    Present address: , No. 45 Changchun Street, Xicheng District, Beijing, 10053, China

  2. Xin Su, Zihao Song and Tianqi Tu contributed equally.

Authors and Affiliations

  1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China

    Xin Su, Zihao Song, Tianqi Tu, Ming Ye, Yongjie Ma, Hongqi Zhang & Peng Zhang

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  1. Xin Su
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Contributions

Conception and design: Xin Su, Peng Zhang. Acquisition of data: Xin Su, Zihao Song, Tianqi Tu. Drafting the article: Xin Su. Critically revising the article: Yongjie Ma, Ming Ye, Peng Zhang, Hongqi Zhang. All of the authors have read and approved the final manuscript.

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Correspondence to Yongjie Ma, Hongqi Zhang or Peng Zhang.

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Ethical approval

This retrospective study involved human participants and was approved by Ethics Committee of Xuanwu Hospital, Capital Medical University [2017; 010].

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The authors declare no competing interests.

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Su, X., Song, Z., Tu, T. et al. Middle cranial fossa non-cavernous sinus dural arteriovenous fistulas: 20 years of experience. Neurosurg Rev 47, 46 (2024). https://doi.org/10.1007/s10143-023-02274-z

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