Alternative management considerations for ethmoidal dural arteriovenous fistulas.
BACKGROUND
Ethmoidal dural arteriovenous fistulas (EDAFs) are an unusual type of intracranial vascular lesion that commonly present with acute hemorrhage. They are often best treated surgically; however, recent endovascular advances raise questions concerning the best therapeutic approach.


METHODS
We present 7 cases of EDAFs managed at this institution over a 6-year period, which demonstrate the broad spectrum of clinical behavior associated with the lesions. Four patients presented with intracranial hemorrhage, 1 patient with rapidly progressive dementia, 1 patient with a proptotic, red eye, and 1 with a retro-orbital headache.


RESULTS
One patient underwent no treatment, 1 underwent embolization alone, 2 underwent embolization and resection, and 3 patients underwent resection alone. There was complete obliteration of the EDAF in all of the patients who underwent surgical resection. Embolization was performed through the external carotid circulation and not the ophthalmic artery. There were no treatment-related neurologic deficits.


CONCLUSIONS
Treatment is best managed with a multidisciplinary approach, which emphasizes complete resection of the lesions with assistance from interventional neuroradiology techniques. However, each patient must be evaluated independently as treatment may vary depending on the angioarchitecture of the lesion.
Abrahams
John M
JM
Department of Neurosurgery, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19107, USA.
Bagley
Linda J
LJ
Flamm
Eugene S
ES
Hurst
Robert W
RW
Sinson
Grant P
GP
D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D035262:Cranial Fossa, Anterior / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D004621:Embolization, Therapeutic; D005004:Ethmoid Bone / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011859:Radiography