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Alternative management considerations for ethmoidal dural arteriovenous fistulas
John M Abrahams1, Linda J Bagley, Eugene S Flamm
1Department of Neurosurgery, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA.
Surgical Neurology
|January 9, 2003
Summary
Ethmoidal dural arteriovenous fistulas (EDAFs) are rare intracranial vascular lesions. Complete surgical resection, often with interventional neuroradiology, is the recommended treatment for these fistulas.
Area of Science:
- Neurosurgery
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Ethmoidal dural arteriovenous fistulas (EDAFs) are uncommon intracranial vascular malformations.
- EDAFs frequently present with acute intracranial hemorrhage.
- Surgical intervention has been the traditional treatment, but endovascular techniques are evolving.
Purpose of the Study:
- To review the clinical presentation and management outcomes of ethmoidal dural arteriovenous fistulas.
- To evaluate the efficacy of surgical resection versus endovascular embolization for EDAFs.
- To determine the optimal therapeutic strategy for EDAFs based on lesion characteristics.
Main Methods:
- Retrospective case series of 7 patients with EDAFs managed over a 6-year period.
- Analysis of clinical presentations, including hemorrhage, dementia, proptosis, and headache.
- Review of treatment modalities: observation, embolization, surgical resection, or combined approaches.
Main Results:
- Patients presented with diverse symptoms, including hemorrhage, dementia, and ocular/orbital complaints.
- Complete fistula obliteration was achieved in all patients undergoing surgical resection.
- No treatment-related neurological deficits were observed in any patient.
Conclusions:
- A multidisciplinary approach combining surgical resection and interventional neuroradiology is recommended for EDAFs.
- Complete resection is crucial for successful treatment outcomes.
- Individualized patient evaluation is necessary due to variations in lesion angioarchitecture and presentation.