Article Figures & Data
Figures
- Fig 1.
Sample case of a DAVF without angioarchitectural features with a negative influence on the treatment success. A DAVF with direct cortical venous drainage (Cognard type III), located at the tentorium in a 65-year-old man with headaches (A). Involved feeding arteries are the middle meningeal artery (black arrows in A) and the occipital artery (white arrows in A), which shunt directly into a cortical vein (white arrowheads). There were <10 feeding arteries, and the ascending pharyngeal artery was not involved. The DAVF could be occluded completely by transarterial embolization with Onyx (B). DSA 6 months after embolization shows stable occlusion of the DAVF (C).
- Fig 2.
Sample case of a DAVF presenting with angioarchitectural features with a negative influence on the treatment success. A DAVF is located at the transverse and sigmoid sinus with antegrade flow in the sinus (Cognard type I) in a 46-year-old man who presented with severe pulsatile tinnitus (A). Multiple feeders supply the DAVF, including the middle meningeal artery (black arrows in A), the occipital artery (white arrows in A), and the ascending pharyngeal artery (black arrowheads in A). The DAVF was treated by transarterial Onyx embolization in combination with transvenous balloon-assisted protection of the venous sinus (B). The DAVF could not be occluded completely, due to small branches of the middle meningeal artery (black arrows in C) and of the occipital artery (white arrows in C), and particularly because of multiple persistent feeders from the ascending pharyngeal artery (black arrowheads in C), which could not be catheterized distal enough because of their small size and their tortuosity. The patient’s symptoms were declining but still persistent at the latest follow-up.
Tables
Feature No. (relative frequency) Location Transverse and/or sigmoid sinus 46 (41.8%) Tentorial/petrosal 25 (22.7%) Superior sagittal sinus 20 (18.2%) Torcular 7 (6.4%) Anterior cranial fossa 6 (5.5%) Sphenoparietal sinus 4 (3.6%) Others 2 (1.8%) Cognard and Borden type Cognard I 12 (10.9%) Cognard IIa 7 (6.4%) Cognard IIb 2 (1.8%) Cognard IIa+b 10 (9.1%) Cognard III 28 (25.5%) Cognard IV 51 (46.4%) Borden I 19 (17.3%) Borden II 11 (10.9%) Borden III 79 (71.8%) Feeder territories Middle meningeal artery 96 (87.3%) Occipital artery 83 (75.5%) Internal carotid artery (dural branches) 41 (37.3%) Verterbral artery (dural branches) 41 (37.3%) Superficial temporal artery 32 (29.1%) Ascending pharyngeal artery 27 (24.5%) Other features DAVFs with <10 arterial feeders 56 (50.9%) DAVFs with ≥10 arterial feeders 54 (49.1%) Bilateral feeders 56 (50.9%) Pial artery supply 41 (37.3%) Parameter No. (relative frequency) / Mean ± SD Selected feeder for embolization Middle meningeal artery 86 (65.2%) Occipital artery 31 (23.5%) Others 14 (10.6%) No. of embolization positions 1 103 (78.0%) 2 24 (18.2%) 3 4 (3.0%) Embolization technique Onyx transarterial 76 (57.6%) Onyx transarterial combined with venous balloon protection 28 (21.2%) Onyx transarterial with a dual-lumen balloon catheter 19 (14.4%) Onyx transvenous combined with coiling 3 (2.3%) Others 7 (5.3%) Complications Overall complications 11 (8.3%) Asymptomatic complications 6 (4.5%) Transient symptomatic complications 3 (2.3%) Permanent complicationsa 2 (1.5%) Follow-up Follow-up period (mo) 23.6 ± 23.5 Total follow-up time (patient yr) 216.3 Angiographic outcome Initial complete angiographic occlusion 86 (78.2%) Spontaneous occlusion after subtotal endovascular occlusion 14 (12.7%) Time period from last treatment to diagnosis of spontaneous occlusion (months) 6.6 ± 8.1 Overall complete occlusion at last examination 100 (90.9%) Recurrence 4 (3.6%) Clinical outcome Preinterventional mRS score 0.8 ± 0.9 Postinterventional mRS score at discharge 0.7 ± 1.1 Postinterventional mRS score at 6 mo after treatment 0.4 ± 0.9 Complete symptom remission after treatment 73 (66.4%) Symptom relief after treatment 32 (29.1%) Stable symptoms after treatment 3 (2.7%) Worsening of symptoms after treatment 2 (1.8%) Treatment successb 90 (81.8%) - Table 3:
Influence of angioarchitectural features on the treatment success—summary and univariate models
Angioarchitectural Feature, Treatment Success Rate P Value (Univariate Analysis) Location Transverse/Sigmoid Sinus, 80.4% Tentorial/Petrosal, 72.0% Superior Sagittal Sinus, 95.0% Torcular, 100% Anterior Cranial Fossa, 83.3% Sphenoparietal Sinus, 75.0% .084 Cognard type I, 60.0% IIa, 75.0% IIb, 100% IIa+b 70.0% III, 96.4% IV, 80.4% .047a Borden type I, 66.7% II, 76.9% III, 86.1% .144 Venous drainage Into dural venous sinus, 71.4% Directly into cortical veins, 85.4% .099 Presence of cortical venous reflux Yes, 85.9% No, 61.1% .013 No. of feeding arteries <10, 92.6% ≥10, 71.4% .004a Bilateral feeders Yes, 83.3% No, 80.4% .686 Pial artery supply Yes, 77.8% No, 83.1% .531 Involvement of the middle meningeal artery Yes, 80.2% No, 92.9% .252 Involvement of the occipital artery Yes, 80.7% No, 85.2% .602 Involvement of the internal carotid arteryb Yes, 70.7% No, 88.4% .020a Involvement of the vertebral arteryb Yes, 75.6% No, 85.5% .193 Involvement of the superficial temporal artery Yes, 81.3% No, 82.1% .921 Involvement of the ascending pharyngeal artery Yes, 61.5% No, 88.1% .002a - Table 4:
Influence of angioarchitectural features on the treatment success—final multivariable logistic regression model
Angioarchitectural Feature P Value Odds Ratio (95% Confidence Interval) No. of feeding arteries .041 0.278 (0.081–0.949) Involvement of the ascending pharyngeal artery .039 0.319 (0.107–0.945)
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