American Journal of Neuroradiology 2009;30:1173.
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American Journal of Neuroradiology
DOI 10.3174/ajnr.A1528
INTERVENTIONAL
Intraosseous Cranial Dural Arteriovenous Fistula Treated with Transvenous Embolization
From the Departments of Radiology (C.J., B.J.K., M.H.H.) and Neurosurgery (O.-K.K., M.H.H., J.E.K., C.W.O.), and Institute of Radiation Medicine (M.H.H.), Seoul National University College of Medicine, Seoul, Korea; Departments of Radiology (C.J.) and Neurosurgery (O.-K.K., C.W.O.), Seoul National University Bundang Hospital, Seongnam, Korea; Departments of Radiology (B.J.K., M.H.H.) and Neurosurgery (J.E.K.), and Clinical Research Institute (M.H.H.), Seoul National University Hospital, Seoul, Korea; and Department of Radiology (S.K.B.), Pusan National University Yangsan Hospital, Busan, Korea.
Please address correspondence to Moon Hee Han, MD, PhD, Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul 110–744, Korea; e-mail: hanmh{at}snuh.org
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.