Skip to main content

Advertisement

SpringerLink
Log in

Anterior Cranial Fossa Dural Arteriovenous Fistulae – Angioarchitecture and Intervention

  • Original Article
  • Published:
Clinical Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

Anterior cranial fossa (ACF) dural arteriovenous fistulae (DAVF) are rare, unique, and ominous. While surgical disconnection is considered as the favored management option, endovascular treatment has lately gained importance. We present a single institution experience of seven cases.

Method

A retrospective analysis was performed on the institutional patient database. Features analyzed were demographic details, symptoms, angioarchitecture, treatment course, angiographic results, procedural complications, and follow-up.

Results

This study included seven patients. The age at presentation ranged from 5–67 years. Clinical symptomatology was as intracranial hemorrhage in 4 patients and headache, chemosis and seizures in one patient each. The fistulae were paramedian at the ACF base. All DAVFs were Cognard type 4. The arterial feeders were from the anterior ethmoidal branches of the ophthalmic artery in all cases (bilateral in n = 5), frontal branches of the middle meningeal artery (MMA) (n = 6), and multiple ECA branches. The arterial route was the choice for access. Complete fistula obliteration was achieved in all but one patient. A traversed vein underwent rupture in one patient. One patient suffered postsurgical hemorrhage. No clinical or angiographic recurrence was noted.

Conclusion

The DAVFs of the ACF are inherently high-grade lesions. Transorbital ECA-ICA branch anastomoses may be recruited as feeders. They may be best managed by multidisciplinary means personalized on an angioarchitectural basis. Endovascular embolization is safe and efficacious when performed through a navigable feeder from the frontal division of the MMA, which according to our interpretation is in anastomosis with the anterior falcine branch of the anterior ethmoidal artery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

ACF:

Anterior cranial fossa

AEA:

Anterior ethmoidal artery

AVM:

Arteriovenous malformation

BVR:

Basal vein of Rosenthal

CT:

Computed tomography

DAVF:

Dural arteriovenous fistulae

ECA:

External carotid artery

ICA:

Internal carotid artery

IMA:

Internal maxillary artery

MMA:

Middle Meningeal Artery

MRI:

Magnetic resonance imaging

SOV:

Superior ophthalmic vein

References

  1. Kwon BJ, Han MH, Kang HS, Chang KH. MR imaging findings of intracranial dural arteriovenous fistulas: relations with venous drainage patterns. AJNR Am J Neuroradiol. 2005;26:2500–7.

    PubMed  PubMed Central  Google Scholar 

  2. Zipfel GJ, Shah MN, Refai D, Dacey RG, Derdeyn CP. Cranial dural arteriovenous fistulas: modification of angiographic classification scales based on new natural history data. Neurosurg Focus. 2009;26:E14.

    Article  Google Scholar 

  3. van Dijk JMC, terBrugge KG, Willinsky RA, Wallace MC. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke. 2002;33:1233–6.

    Article  Google Scholar 

  4. Xu K, Ji T, Li C, Yu J. Current status of endovascular treatment for dural arteriovenous fistulae in the anterior cranial fossa: a systematic literature review. Int J Med Sci. 2019;16:203–11.

    Article  Google Scholar 

  5. Gross BA, Moon K, Kalani MY, Albuquerque FC, McDougall CG, Nakaji P, Zabramski JM, Spetzler RF. Clinical and anatomic insights from a series of ethmoidal dural arteriovenous fistulas at Barrow Neurological Institute. World Neurosurg. 2016;93:94–9.

    Article  Google Scholar 

  6. Meneghelli P, Pasqualin A, Lanterna LA, Bernucci C, Spinelli R, Dorelli G, Zampieri P. Surgical treatment of anterior cranial fossa dural arterio-venous fistulas (DAVFs): a two-centre experience. Acta Neurochir (Wien). 2017;159:823–30.

    Article  Google Scholar 

  7. Agid R, Terbrugge K, Rodesch G, Andersson T, Söderman M. Management strategies for anterior cranial fossa (ethmoidal) dural arteriovenous fistulas with an emphasis on endovascular treatment. J Neurosurg. 2009;110:79–84.

    Article  Google Scholar 

  8. Kobayashi H, Hayashi M, Noguchi Y, Tsuji T, Handa Y, Caner HH. Dural arteriovenous malformations in the anterior cranial fossa. Surg Neurol. 1988;30:396–401.

    Article  CAS  Google Scholar 

  9. Defreyne L, Vanlangenhove P, Vandekerckhove T, Deschrijver I, Sieben G, Klaes R, Kunnen M. Transvenous embolization of a dural arteriovenous fistula of the anterior cranial fossa: preliminary results. AJNR Am J Neuroradiol. 2000;21:761–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Li Q, Fang YB, Huang QH, Zhang Q, Hong B, Zhao WY, Liu JM, Xu Y. Transarterial embolization of dural arteriovenous fistulas of the anterior cranial fossa with Onyx. J Clin Neurosci. 2013;20:287–91.

    Article  Google Scholar 

  11. Lee B, Mehta VA, Amar AP, Tenser MS, Mack WJ. Transarterial embolization of an anterior fossa cranial base dural arteriovenous fistula. Neurosurg Focus. 2014;37(1 Suppl):1.

    CAS  PubMed  Google Scholar 

  12. Deng JP, Li J, Zhang T, Yu J, Zhao ZW, Gao GD. Embolization of dural arteriovenous fistula of the anterior cranial fossa through the middle meningeal artery with Onyx. Clin Neurol Neurosurg. 2014;117:1–5.

    Article  Google Scholar 

  13. Lepoire J, Montaut J, Bouchot M, Laxenaire M. Intrafrontal arteriovenous aneurysms vascularized by the anterior ethmoidal artery. Apropos of 3 cases. Neurochirurgie. 1963;9:159–66.

    CAS  PubMed  Google Scholar 

  14. Lasjaunias P, Chiu M, ter Brugge K, Tolia A, Hurth M, Bernstein M. Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg. 1986;64:724–30.

    Article  CAS  Google Scholar 

  15. Başkaya MK, Suzuki Y, Seki Y, Negoro M, Ahmed M, Sugita K. Dural arteriovenous malformations in the anterior cranial fossa. Acta Neurochir. 1994;129:146–51.

    Article  Google Scholar 

  16. Gross BA, Du R. The natural history of cerebral dural arteriovenous fistulae. Neurosurgery. 2012;71:594–602. discussion 602–3.

    Article  Google Scholar 

  17. Reynolds MR, Lanzino G, Zipfel GJ. Intracranial dural arteriovenous fistulae. Stroke. 2017;48:1424–31.

    Article  Google Scholar 

  18. Bulters DO, Mathad N, Culliford D, Millar J, Sparrow OC. The natural history of cranial dural arteriovenous fistulae with cortical venous reflux—the significance of venous ectasia. Neurosurgery. 2012;70:312–9.

    Article  Google Scholar 

  19. Martin NA, King WA, Wilson CB, Nutik S, Carter LP, Spetzler RF. Management of dural arteriovenous malformations of the anterior cranial fossa. J Neurosurg. 1990;72:692–7.

    Article  CAS  Google Scholar 

  20. Abrahams JM, Bagley LJ, Flamm ES, Hurst RW, Sinson GP. Alternative management considerations for ethmoidal dural arteriovenous fistulas. Surg Neurol. 2002;58:410–6.

    Article  Google Scholar 

  21. Deshmukh VR, Chang S, Albuquerque FC, McDougall CG, Spetzler RF. Bilateral ethmoidal dural arteriovenous fistulae: a previously unreported entity: case report. Neurosurgery. 2005;57:E809.

    Article  Google Scholar 

  22. Inoue A, Tagawa M, Kumon Y, Watanabe H, Shoda D, Sugiu K, Ohnishi T. Ethmoidal dural arteriovenous fistula with unusual drainage route treated by transarterial embolization. BMJ Case Rep. 2014;2014:bcr2013011098.

  23. Shumway CL, Motlagh M, Wade M. Anatomy, Head and Neck, Orbit Bones. 2019 Jun 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.

  24. Geibprasert S, Pongpech S, Armstrong D, Krings T. Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know. AJNR Am J Neuroradiol. 2009;30:1459–68.

    Article  CAS  Google Scholar 

  25. Martins C, Yasuda A, Campero A, Ulm AJ, Tanriover N, Rhoton A Jr. Microsurgical anatomy of the dural arteries. Neurosurgery. 2005;56(2 Suppl):211-51; discussion 211–51.

    Article  Google Scholar 

  26. Bracco S, Venturi C, Leonini S, Romano DG, Cioni S, Vallone IM, Gennari P, Hadjistilianou T, De Francesco S, Bertelli E. Transorbital anastomotic pathways between the external and internal carotid systems in children affected by intraocular retinoblastoma. Surg Radiol Anat. 2016;38:79–87.

    Article  Google Scholar 

  27. Ogawa T, Okudera T, Miyauchi T, Inugami A, Uemura K, Yasui N. Anterior cranial fossa dural arteriovenous fistula with a varix mimicking an anterior communicating artery aneurysm. Neuroradiology. 1996;38:252–3.

    Article  CAS  Google Scholar 

  28. Halbach VV, Higashida RT, Hieshima GB, Wilson CB, Barnwell SL, Dowd CF. Dural arteriovenous fistulas supplied by ethmoidal arteries. Neurosurgery. 1990;26:816–23.

    Article  CAS  Google Scholar 

  29. Tahon F, Salkine F, Amsalem Y, Aguettaz P, Lamy B, Turjman F. Dural arteriovenous fistula of the anterior fossa treated with the onyx liquid embolic system and the sonic microcatheter. Neuroradiology. 2008;50:429–32.

    Article  Google Scholar 

  30. Jiang C, Lv X, Li Y, Wu Z. Transarterial Onyx packing of the transverse-sigmoid sinus for dural arteriovenous fistulas. Eur J Radiol. 2011;80:767–70.

    Article  Google Scholar 

  31. Cannizzaro D, Peschillo S, Cenzato M, Pero G, Resta MC, Guidetti G, Burdi N, Piccirilli M, Santoro A, Lanzino G. Endovascular and surgical approaches of ethmoidal dural fistulas: a multicenter experience and a literature review. Neurosurg Rev. 2018;41:391–8.

    Article  CAS  Google Scholar 

  32. Limbucci N, Leone G, Nappini S, Rosi A, Renieri L, Consoli A, Pedicelli A, Mangiafico S. Transvenous Embolization of Ethmoidal Dural Arteriovenous Fistulas: Case Series and Review of the Literature. World Neurosurg. 2018;110:e786–93.

    Article  Google Scholar 

  33. Albuquerque FC, Ducruet AF, Crowley RW, Bristol RE, Ahmed A, McDougall CG. Transvenous to arterial Onyx embolization. J Neurointerv Surg. 2014;6:281–5.

    Article  Google Scholar 

  34. Spiotta AM, Hawk H, Kellogg RT, Turner RD, Chaudry MI, Turk AS. Transfemoral venous approach for Onyx embolization of anterior fossa dural arteriovenous fistulae. J Neurointerv Surg. 2014;6:195–9.

    Article  Google Scholar 

  35. Lv X, Li Y, Wu Z. Endovascular treatment of anterior cranial fossa dural arteriovenous fistula. Neuroradiology. 2008;50:433–7.

    Article  Google Scholar 

  36. Roa JA, Dabus G, Dandapat S, Hasan D, Samaniego EA. Ethmoidal dural arteriovenous fistulas: endovascular transvenous embolization technique. J Neurointerv Surg. 2020;12:610.

    Article  Google Scholar 

  37. Mendes GA, Caire F, Saleme S, Ponomarjova S, Mounayer C. Retrograde leptomeningeal venous approach for dural arteriovenous fistulas at foramen magnum. Interv Neuroradiol. 2015;21:244–8.

    Article  Google Scholar 

  38. Piergallini L, Tardieu M, Cagnazzo F, Gascou G, Dargazanli C, Derraz I, Costalat V, Bonafé A, Lefevre PH. Anterior cranial fossa dural arteriovenous fistula: Transarterial embolization from the ophthalmic artery as first-line treatment. J Neuroradiol. 2019. https://doi.org/10.1016/j.neurad.2019.05.009. Epub ahead of print.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, 560029, Bengaluru, Karnataka, India

    Karthik Kulanthaivelu, Hima Pendharkar, Chandrajit Prasad, Arun Kumar Gupta, Arvinda Hanumanthapura Ramalingaiah & Jitender Saini

  2. Department of Neurosurgery, National Institute of Mental Health and Neurosciences, 560029, Bengaluru, Karnataka, India

    Dwarakanath Srinivas

Authors
  1. Karthik Kulanthaivelu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hima Pendharkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chandrajit Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arun Kumar Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Arvinda Hanumanthapura Ramalingaiah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jitender Saini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dwarakanath Srinivas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chandrajit Prasad.

Ethics declarations

Conflict of interest

K. Kulanthaivelu, H. Pendharkar, C. Prasad, A. Kumar Gupta, A. Hanumanthapura Ramalingaiah, J. Saini and D. Srinivas declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kulanthaivelu, K., Pendharkar, H., Prasad, C. et al. Anterior Cranial Fossa Dural Arteriovenous Fistulae – Angioarchitecture and Intervention. Clin Neuroradiol 31, 661–669 (2021). https://doi.org/10.1007/s00062-020-00932-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00062-020-00932-z

Keywords

Search

Navigation