Dural Arteriovenous Fistulae Static or Dynamic? Cognard et al –seven patients with documented worsening of venous drainage –aggressive natural history.

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Presentation transcript:

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

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

Dural AVFs Experimental 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

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

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

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

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

Surgical Disconnection: Work in Progress Norris J et al 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

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

Cavernous Malformations