PT  - JOURNAL ARTICLE
AU  - Z.-S. Shi
AU  - J. Ziegler
AU  - L. Feng
AU  - N.R. Gonzalez
AU  - S. Tateshima
AU  - R. Jahan
AU  - N.A. Martin
AU  - F. Viñuela
AU  - G.R. Duckwiler
TI  - Middle Cranial Fossa Sphenoidal Region Dural Arteriovenous Fistulas: Anatomic and Treatment Considerations
AID  - 10.3174/ajnr.A3193
DP  - 2012 Jul 12
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2012/07/12/ajnr.A3193.short
4100  - http://www.ajnr.org/content/early/2012/07/12/ajnr.A3193.full
AB  - BACKGROUND AND PURPOSE: DAVFs rarely involve the sphenoid wings and middle cranial fossa. We characterize the angiographic findings, treatment, and outcome of DAVFs within the sphenoid wings. MATERIALS AND METHODS: We reviewed the clinical and radiologic data of 11 patients with DAVFs within the sphenoid wing that were treated with an endovascular or with a combined endovascular and surgical approach. RESULTS: Nine patients presented with ocular symptoms and 1 patient had a temporal parenchymal hematoma. Angiograms showed that 5 DAVFs were located on the lesser wing of sphenoid bone, whereas the other 6 were on the greater wing of the sphenoid bone. Multiple branches of the ICA and ECA supplied the lesions in 7 patients. Four patients had cortical venous reflux and 7 patients had varices. Eight patients were treated with transarterial embolization using liquid embolic agents, while 3 patients were treated with transvenous embolization with coils or in combination with Onyx. Surgical disconnection of the cortical veins was performed in 2 patients with incompletely occluded DAVFs. Anatomic cure was achieved in all patients. Eight patients had angiographic and clinical follow-up and none had recurrence of their lesions. CONCLUSIONS: DAVFs may occur within the dura of the sphenoid wings and may often have a presentation similar to cavernous sinus DAVFs, but because of potential associations with the cerebral venous system, may pose a risk for intracranial hemorrhage. Curative embolization through a transarterial or transvenous approach is the primary therapeutic strategy for these lesions. In incompletely embolized patients, exclusion of any refluxing cortical veins is necessary. Abbreviations DAVFdural arteriovenous fistulaECAexternal carotid arteryGDCGuglielmi detachable coilMMAmiddle meningeal arteryn-BCAn-butyl cyanoacrylateSMCVsuperficial middle cerebral veinSOVsuperior ophthalmic vein