Related Experiment Video
Updated: Jun 25, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Intraosseous cranial dural arteriovenous fistula treated with transvenous embolization
1Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Insights
Transvenous embolization effectively treats intraosseous dural arteriovenous fistulas (DAVFs). Targeting the dilated venous pouch offers a curative endovascular approach for these complex vascular lesions.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Neuroimaging
Background:
- Intraosseous dural arteriovenous fistulas (DAVFs) present unique diagnostic and therapeutic challenges.
- Understanding the angiographic architecture is crucial for effective management.
Purpose of the Study:
- To analyze the angiographic features of intraosseous DAVFs.
- To evaluate the efficacy of transvenous embolization as a curative treatment.
Main Methods:
- Retrospective review of 6 patients with intraosseous DAVFs across three institutions.
- Utilized CT, MR imaging, and 3D rotational angiography for lesion confirmation and characterization.
- Transvenous embolization targeted the dilated intraosseous venous pouch and its feeders.
Main Results:
- Intraosseous DAVFs were located in the clivus and petrous apex.
- All lesions featured a dilated venous pouch, appearing as osteolytic or signal-void areas on imaging.
- Transvenous embolization achieved complete occlusion in 4 patients, with resolution in another. No complications occurred.
Conclusions:
- Transvenous embolization is a safe and curative treatment for intraosseous DAVFs.
- The dilated intraosseous venous pouch serves as an effective target for endovascular therapy.
Background And Purpose:
We analyzed the angiographic architecture of intraosseous dural arteriovenous fistulas (DAVFs) and evaluated the use of transvenous embolization for curative treatment.
Materials And Methods:
The study population consisted of 6 patients with intraosseous DAVFs from 3 hospitals. In all of these patients, we retrospectively reviewed the medical records and images, and we were able to confirm the lesions in all patients from CT, MR imaging, and angiographic images. 3D rotational angiographic coronal source images clearly demonstrated the presence of an intraosseous DAVF in 2 patients.
Results:
An intraosseous DAVF was located at the upper clivus in 1, the petrous apex in 1, and the lower clivus adjacent to the hypoglossal canal in 4 cases. All of the cases showed the presence of a dilated venous pouch, manifest as an osteolytic lesion on CT and as an intraosseous signal-intensity void on MR images. All patients were treated with transvenous embolization by targeting the dilated venous pouch and its connecting tributaries. Four intraosseous DAVFs were immediately completely embolized. One patient had a residual shunt, but the shunt disappeared 1 month later. One patient presented with a simultaneous DAVF in the ipsilateral cavernous sinus without a significant amount of shunt. None of the patients had procedural complications, and 5 patients recovered from the presenting symptoms.
Conclusions:
An intraosseous DAVF could be completely cured with transvenous embolization. For curative treatment, the intraosseous dilated venous pouch can be the target lesion for endovascular treatment.
