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Dural Arteriovenous Fistulae Static or Dynamic? PowerPoint Presentation
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Dural Arteriovenous Fistulae Static or Dynamic?

Dural Arteriovenous Fistulae Static or Dynamic?

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Dural Arteriovenous Fistulae Static or Dynamic?

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  1. Dural Arteriovenous Fistulae Static or Dynamic? • Cognard et al • seven patients with documented worsening of venous drainage • aggressive natural history • Neuroradiology 39:59, 1997

  2. Dural AVFsExperimental Investigation Common carotid/external jugular anstamosis Dural AVFs only with sinus thrombosis J Neurosurg 80:884, 1994 J Neurosurg 83:539, 1995

  3. 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

  4. Dural Arteriovenous Fistulae Etiology • Arteriovenous malformation affecting the transverse dural venous sinus - an aquired lesion • Houser et al. Mayo Clin Proc 54:651, 1979

  5. Dural Arteriovenous Fistulae Embolization • Transarterial and/or Transvenous • Symptom palliation • Angiographic cure

  6. Transvenous Embolization Venous access Indication for therapy 24 patients 4% perm morbidity 96% clinical cure Roy & Raymond Neurosurgery 40:1133, 1997

  7. Dural Arteriovenous Fistulae Surgical Options • resection • packing • Endo et al J Neurosurg 88:449, 1998 • disconnection • Collice et al J Neurosurg 84:810, 1996

  8. 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

  9. Dural Arteriovenous Fistulae:Radiation? • case reports • biological target • target size eg thickness • indication for therapy • time to cure vs natural history

  10. Cavernous Malformations