title: Non-galenic arteriovenous fistulas in adults: transarterial embolization and literature review.
abstract: BACKGROUND
  Non-galenic dural arteriovenous fistula (NGAVF) is a rare congenital vascular abnormality characterized by high flow connections between cerebral arteries and a dilated pial venous varix. These lesions have been reported mostly in the pediatric population.
  
  
  OBJECTIVE
  To examine the clinical features and treatment outcomes for adult (≥ 18 years) patients with NGAVFs.
  
  
  METHODS
  We retrospectively reviewed the records of patients with NGAVFs who underwent endovascular treatment between 2008 and 2013. A PubMed literature search was conducted to identify reports of adult patients with these lesions.
  
  
  RESULTS
  Two adults with NGAVFs were treated at our institution via transarterial embolization with a favorable outcome. The literature search revealed 24 adult NGAVF cases. Among these cases and ours, mean patient age was 33.4 ± 13.3 years, and 13 were women. Most patients experienced protracted neurological symptoms at the time of treatment whereas 5 (19.2%) patients presented with acute hemorrhage. 18 patients had single hole fistulas; 8 had multi-hole fistulas. 11 patients were treated by microsurgical ligation, 10 by embolization, 4 by combined therapy, and 1 with observation. Two patients died of reperfusion hemorrhage. Women were more likely to have a favorable outcome than men (100% vs 75.0%; p=0.07). No statistical difference was found in terms of clinical outcome for patients with single hole versus multi-hole fistulas or those treated by surgery versus embolization.
  
  
  CONCLUSIONS
  NGAVFs are extremely rare in the adult population and present a similar clinical course as in older children. In our experience, transarterial embolization can be safely and effectively utilized for the treatment of these lesions in adults.
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, New York, USA.
authors.forename: Ning
authors.initials: N
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, New York, USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brouillard
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.affiliation: Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute/Kaleida Health, Buffalo, New York, USA Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Jacobs Institute, Buffalo, New York, USA.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000628:therapy*; D008297:Male; D008875:Middle Aged
keywords: Arteriovenous Malformation; Fistula; Intervention; Technique