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Cranial dural arteriovenous shunts: selection of the ideal lesion for surgical occlusion according to the classification system

  • Original Article - Vascular Neurosurgery - Arteriovenous malformation
  • Published:
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Abstract

Background

The types of cranial dural arteriovenous fistulae (cDAVFs) that constitute good surgical candidates are unclear despite the use of classifications. We aimed to compare the DES classification with other classification schemes in identifying “ideal lesions for surgery.” The DES scheme is based on two features: the level of the shunt (BVS, bridging vein shunt; DSS, dural sinus shunt; ISS, isolated sinus shunt; EVS, emissary vein shunt) and the type of leptomeningeal venous reflux (LVR) (direct, exclusive, strained).

Methods

In this observational cohort study, the angiographies of 20 consecutive patients treated over 1 year were analyzed retrospectively. We defined cDAVFs as ideal for surgery, if cure may be achieved by disconnecting the arterialized draining vein through a single craniotomy. To evaluate the performance of each classification scheme in identifying the “ideal lesion for surgery,” we carried out a sensitivity analysis of the Borden, Cognard, and DES schemes.

Results

Eight lesions were Borden type 3 and 1 type 2, and 11 type 1. According to Cognard, 2 lesions were type IV, 2 type III, 1 type IIa+b, 11 type I, and 4 lesions could not be clearly classified. According to the DES scheme, 8 lesions were DSS, 4 BVS, 3 ISS, and 5 EVS. All 4 lesions classified as BVS in the DES were ideal lesions for surgery (sensitivity, specificity, PPV, NPV 100%). Not all high-grade lesions according to Borden were good surgical candidates.

Conclusion

The DES scheme, as opposed to other classifications, facilitates the therapeutic decision-making especially for selecting candidates for surgery.

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References

  1. Agid R, Terbrugge K, Rodesch G et al (2009) Management strategies for anterior cranial fossa (ethmoidal) dural arteriovenous fistulas with an emphasis on endovascular treatment. J Neurosurg 110(1):79–84

    Article  PubMed  Google Scholar 

  2. Al-Mahfoudh R, Kirollos R, Mitchell P et al (2015) Surgical disconnection of the cortical venous reflux for high-grade intracranial dural arteriovenous fistulas. World Neurosurg 83(4):652–656

    Article  PubMed  Google Scholar 

  3. Baltsavias G, Valavanis A (2014) Endovascular treatment of 170 consecutive cranial dural arteriovenous fistulae: results and complications. Neurosurg Rev 37(1):63–71

    Article  PubMed  Google Scholar 

  4. Baltsavias G, Kumar R, Avinash KM et al (2015) Cranial dural arteriovenous shunts. Part 2. The shunts of the bridging veins and leptomeningeal venous drainage. Neurosurg Rev 38(2):265–271 discussion 272

    Article  PubMed  Google Scholar 

  5. Baltsavias G, Parthasarathi V, Aydin E et al (2015) Cranial dural arteriovenous shunts. Part 1. Anatomy and embryology of the bridging and emissary veins. Neurosurg Rev 38(2):253–263 discussion 263-254

    Article  PubMed  Google Scholar 

  6. Baltsavias G, Roth P, Valavanis A (2015) Cranial dural arteriovenous shunts. Part 3. Classification based on the leptomeningeal venous drainage. Neurosurg Rev 38(2):273–281 discussion 281

    Article  PubMed  Google Scholar 

  7. Baltsavias G, Spiessberger A, Hothorn T et al (2015) Cranial dural arteriovenous shunts. Part 4. Clinical presentation of the shunts with leptomeningeal venous drainage. Neurosurg Rev 38(2):283–291 discussion 291

    Article  PubMed  Google Scholar 

  8. Borden JA, Wu JK, Shucart WA (1995) A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82(2):166–179

    Article  CAS  PubMed  Google Scholar 

  9. Bulters DO, Mathad N, Culliford D et al (2012) The natural history of cranial dural arteriovenous fistulae with cortical venous reflux--the significance of venous ectasia. Neurosurgery. 70(2):312–318 discussion 318-319

    Article  PubMed  Google Scholar 

  10. Cognard C, Gobin YP, Pierot L et al (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 194(3):671–680

    Article  CAS  PubMed  Google Scholar 

  11. Cognard C, Januel AC, Silva NA Jr et al (2008) Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol 29(2):235–241

    Article  CAS  PubMed  Google Scholar 

  12. Collice M, D'Aliberti G, Talamonti G et al (1996) Surgical interruption of leptomeningeal drainage as treatment for intracranial dural arteriovenous fistulas without dural sinus drainage. J Neurosurg 84(5):810–817

    Article  CAS  PubMed  Google Scholar 

  13. D'Aliberti G, Talamonti G, Collice M (1996) Sinus skeletonization. J Neurosurg 85(4):738–740

    CAS  PubMed  Google Scholar 

  14. Davies MA, TerBrugge K, Willinsky R et al (1996) The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 85(5):830–837

    Article  CAS  PubMed  Google Scholar 

  15. Grisoli F, Vincentelli F, Fuchs S et al (1984) Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space Report of four cases. J Neurosurg 60(5):1059–1066

    Article  CAS  PubMed  Google Scholar 

  16. Gross BA, Du R (2012) The natural history of cerebral dural arteriovenous fistulae. Neurosurgery 71(3):594–602 discussion 602-593

    Article  PubMed  Google Scholar 

  17. Gross BA, Du R (2013) Surgical treatment of high grade dural arteriovenous fistulae. J Clin Neurosci 20(11):1527–1532

    Article  PubMed  Google Scholar 

  18. Hoh BL, Choudhri TF, Connolly ES Jr et al (1998) Surgical management of high-grade intracranial dural arteriovenous fistulas: leptomeningeal venous disruption without nidus excision. Neurosurgery 42(4):796–804 discussion 804-795

    Article  CAS  PubMed  Google Scholar 

  19. Hurley MC, Rahme RJ, Fishman AJ et al (2011) Combined surgical and endovascular access of the superficial middle cerebral vein to occlude a high-grade cavernous dural arteriovenous fistula: case report. Neurosurgery 69(2):E475–E481 discussion E481-472

    Article  PubMed  Google Scholar 

  20. Ishii K, Goto K, Ihara K et al (1987) High-risk dural arteriovenous fistulae of the transverse and sigmoid sinuses. AJNR Am J Neuroradiol 8(6):1113–1120

    CAS  PubMed  Google Scholar 

  21. Kakarla UK, Deshmukh VR, Zabramski JM et al (2007) Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications. Neurosurgery. 61(3):447–457 discussion 457-449

    Article  PubMed  Google Scholar 

  22. Liu JK, Dogan A, Ellegala DB et al (2009) The role of surgery for high-grade intracranial dural arteriovenous fistulas: importance of obliteration of venous outflow. J Neurosurg 110(5):913–920

    Article  PubMed  Google Scholar 

  23. Liu JK, Choudhry OJ, Barnwell SL et al (2012) Single stage transcranial exposure of large dural venous sinuses for surgically-assisted direct transvenous embolization of high-grade dural arteriovenous fistulas: technical note. Acta Neurochir 154(10):1855–1859

    Article  PubMed  Google Scholar 

  24. Sugrue PA, Hurley MC, Bendok BR et al (2009) High-grade dural arteriovenous fistula simulating a bilateral thalamic neoplasm. Clin Neurol Neurosurg 111(7):629–632

    Article  PubMed  Google Scholar 

  25. Sundt TM Jr, Piepgras DG (1983) The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg 59(1):32–39

    Article  PubMed  Google Scholar 

  26. Thomas AJ, Ogilvy CS (2015) Treatment of dural arteriovenous fistulas with cortical venous reflux-endovascular therapy and surgery preferred modality of treatment. World Neurosurg 83(6):1053–1054

    Article  PubMed  Google Scholar 

  27. Thompson BG, Doppman JL, Oldfield EH (1994) Treatment of cranial dural arteriovenous fistulae by interruption of leptomeningeal venous drainage. J Neurosurg 80(4):617–623

    Article  CAS  PubMed  Google Scholar 

  28. van Dijk JM, terBrugge KG, Willinsky RA et al (2002) Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke 33(5):1233–1236

    Article  PubMed  Google Scholar 

  29. van Dijk JM, TerBrugge KG, Willinsky RA et al (2004) Selective disconnection of cortical venous reflux as treatment for cranial dural arteriovenous fistulas. J Neurosurg 101(1):31–35

    Article  PubMed  Google Scholar 

  30. Wachter D, Hans F, Psychogios MN et al (2011) Microsurgery can cure most intracranial dural arteriovenous fistulae of the sinus and non-sinus type. Neurosurg Rev 34(3):337–345 discussion 345

    Article  PubMed  PubMed Central  Google Scholar 

  31. Zipfel GJ, Shah MN, Refai D et al (2009) Cranial dural arteriovenous fistulas: modification of angiographic classification scales based on new natural history data. Neurosurg Focus 26(5):E14

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank B. Tarigan PhD for the statistical analysis of the data. We particularly thank Mr. Peter Roth for his excellent drawings.

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Authors and Affiliations

  1. Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Steinradstrasse 23, 8704, Zurich, Switzerland

    Gerasimos Baltsavias & Anton Valavanis

  2. Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland

    Luca Regli

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  1. Gerasimos Baltsavias
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  2. Anton Valavanis
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Correspondence to Gerasimos Baltsavias.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. An Ethics committee approval was obtained (KEK 2016-02126), and all individual participants included in the study signed an informed consent.

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Baltsavias, G., Valavanis, A. & Regli, L. Cranial dural arteriovenous shunts: selection of the ideal lesion for surgical occlusion according to the classification system. Acta Neurochir 161, 1775–1781 (2019). https://doi.org/10.1007/s00701-019-03984-4

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  • DOI: https://doi.org/10.1007/s00701-019-03984-4

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