Endovascular treatment of brain arteriovenous fistulas.

BACKGROUND AND PURPOSE: Brain arteriovenous fistulas (BAVFs) are dangerous lesions with significant risks for hemorrhage and re-hemorrhage; thus, the management of BAVFs is an important subject. Flow disconnection can be accomplished by surgical or endovascular techniques. We reviewed the experience in our endovascular treatment of patients with BAVFs.

MATERIALS AND

METHODS

From March 2006 to March 2008, a total of 9 consecutive patients with nontraumatic BAVFs were treated at Beijing Tiantan Hospital. Dural arteriovenous fistulas and Galen aneurysmal malformations were excluded from this study. We retrospectively reviewed the medical records, cerebral angiograms, and endovascular reports for each patient. Radiographic outcome was assessed by posttreatment angiography. Clinical outcome was assessed for every patient.

RESULTS

There were 9 patients with a total of 11 BAVFs. The mean age at presentation was 17.8 years. The clinical presentations were intracranial hemorrhage in 4 patients, headaches in 2 patients, and seizure in 1 patient, with 2 patients diagnosed incidentally. All lesions were supratentorial, and a venous varix was found on angiographic examination. Seven patients were treated with coils, 1 with Onyx-34, and 1 with a combination of coils and glue. All 9 lesions were completely obliterated as demonstrated on follow-up angiographic examination. With a mean follow-up of 5.7 months (range, 3-12 months), all patients were neurologically excellent with no symptoms (modified Rankin Scale, 0).

CONCLUSIONS

BAVFs are more frequent in younger patients and frequently lead to intracranial hemorrhage. Staged endovascular coil embolization of BAVFs may be a good appropriate treatment technique.