Coil-based endovascular treatment of single-hole cerebral arteriovenous fistulae: experiences in 11 patients

Youn, Sung Won; Han, Moon Hee; Kwon, Bae Ju; Kang, Hyun-Seung; Chang, Hyuk Won; Kim, Bum-Soo

doi:10.1016/j.surneu.2009.06.001

« Previous Next »World Neurosurgery
Volume 73, Issue 1 , Pages 2-10, January 2010

Coil-based endovascular treatment of single-hole cerebral arteriovenous fistulae: experiences in 11 patients

Sung Won Youn, MD
- Department of Radiology, Korea University Anam Hospital, Seoul 136-705, South Korea
- Corresponding author. Tel.: +82 2 920 5657; fax: +82 2 929 3796.
Moon Hee Han, MD
- Department of Radiology and Neurosurgery, Seoul National University Hospital, Seoul 110-744, South Korea
Bae Ju Kwon, MD
- Department of Radiology and Neurosurgery, Seoul National University Hospital, Seoul 110-744, South Korea
Hyun-Seung Kang, MD
- Department of Radiology and Neurosurgery, Seoul National University Hospital, Seoul 110-744, South Korea
Hyuk Won Chang, MD
- Department of Radiology, Keimyung University Dongsan Medical Center, Daegu, Daegu 700-712, South Korea
Bum-Soo Kim, MD
- Department of Radiology, Catholic University Kangnam St. Mary's Hospital, Seoul 505, South Korea

Received 11 February 2009; accepted 4 June 2009. published online 10 August 2009.

Abstract

Background

An SHF is rare pial arteriovenous shunt with no nidal component, of which the feeder drains directly into a single venous channel. Casting with NBCA was described previously, but its control demands operator to accumulate a considerable learning curve. We are to present our experiences of coil-based endovascular treatment of SHF.

Methods

Eleven patients harbored 12 SHFs (5 men, 6 women; mean age, 28.4 years; age range, 4-73 years), and they presented with hemorrhage, seizure, collapse, orbital mass, and as an incidental lesion. The location was frontal for 3, temporal for 5, parietal in 2, and occipital in 2 patients. The angioarchitectures, the methods of endovascular treatment, and outcomes were analyzed.

Results

Fifteen feeders arose from 4 anterior, 8 middle, and 3 posterior cerebral arteries. The coil framework was constructed at the fistula before the penetration of a low concentrated NBCA. Nine fistulae were occluded completely, and 3 fistulae were occluded to near-completion with micro-AVM. There was no recanalization of SHF, either growth of a micro-AVM during follow-up period (mean, 48.3 months; range, 6-120 months). One patient with postprocedure hemorrhage developed hemiplegia, but 1 patient with seizure and the other 9 asymptomatic patients were uneventful.

Conclusions

The coil-based endovascular treatment can achieve safe and stable occlusion of SHF, and the preventions against venous thrombosis and perfusion breakthrough should be essential.

Abbreviations: AVFs, arteriovenous fistulas, ACA, anterior cerebral artery, AVMs, arteriovenous malformations, MRI, magnetic resonance imaging, MCA, middle cerebral artery, NBCA, N-butyl-2-cyanoacrylate, PCA, posterior cerebral artery, SHF, single-hole cerebral AV fistula