Explore two decades of groundbreaking insights and advancements in treating non-cavernous sinus dural arteriovenous fistulas within the middle cranial fossa, a journey through the evolution of neurosurgical expertise.
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Middle cranial fossa non-cavernous sinus dural arteriovenous fistulas: 20 years of experience.
Su et al., Neurosurg Rev 2024
DOI: 10.1007/s10143-023-02274-z
Study Summary:
A retrospective study focused on non-cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) involving the sphenoid bone within the middle cranial fossa. The study included 26 patients, with 15 having DAVFs at the lesser sphenoid wing and 11 at the greater sphenoid wing. A notable 23.1% (6/26) presented with hemorrhage. The most common symptom reported was related to the eyes, affecting 38.5% (10/26) of patients.
Treatment primarily involved trans-arterial embolization (TAE) using liquid embolic agents for 19 patients, while two underwent transvenous embolization (TVE) with Onyx or coils. Surgical intervention was necessary for five patients after unsuccessful TAE. An impressive 92.3% (24/26) achieved anatomic cure, with a follow-up period ranging from 3 to 27 months revealing only one recurrence (8.3%).
Significance:
This study is significant as it highlights the complexity of treating non-CS DAVFs, particularly those involving the sphenoid bone. It demonstrates that the majority of patients can be effectively treated with endovascular methods, though a small percentage may require surgery. The findings contribute to the understanding of the anatomy and treatment outcomes for these rare and challenging DAVFs.