Coil-based endovascular treatment of single-hole cerebral arteriovenous fistulae: experiences in 11 patients.
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.
Youn
Sung Won
SW
Department of Radiology, Korea University Anam Hospital, Seoul, South Korea. liberobh@empal.com
Han
Moon Hee
MH
Kwon
Bae Ju
BJ
Kang
Hyun-Seung
HS
Chang
Hyuk Won
HW
Kim
Bum-Soo
BS
D000293:Adolescent; D000328:Adult; D000368:Aged; D017130:Angioplasty; D001164:Arteriovenous Fistula / Q000150:complications / Q000473:pathology / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult