Middle cranial fossa sphenoidal region dural arteriovenous fistulas: Anatomic and treatment considerations

Z. S. Shi, Jordan Ziegler, L. Feng, N. R. Gonzalez, S. Tateshima, R. Jahan, N. A. Martin, F. Viñuela, Gary R. Duckwiler

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)373-380
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume34
Issue number2
DOIs
StatePublished - Feb 1 2013
Externally publishedYes

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Middle cranial fossa sphenoidal region dural arteriovenous fistulas: Anatomic and treatment considerations'. Together they form a unique fingerprint.

  • Cite this

    Shi, Z. S., Ziegler, J., Feng, L., Gonzalez, N. R., Tateshima, S., Jahan, R., Martin, N. A., Viñuela, F., & Duckwiler, G. R. (2013). Middle cranial fossa sphenoidal region dural arteriovenous fistulas: Anatomic and treatment considerations. American Journal of Neuroradiology, 34(2), 373-380. https://doi.org/10.3174/ajnr.A3193