title: Endovascular and surgical approaches of ethmoidal dural fistulas: a multicenter experience and a literature review.
abstract: Ethmoidal dural arteriovenous fistulae are rare vascular malformations associated with a high risk of bleeding. We present a multicenter contemporary series of patients treated with microsurgical and endovascular techniques. Sixteen consecutive patients were evaluated and/or treated between 2008 and 2015 at four centers with large experience in the endovascular and surgical treatment of cerebrovascular diseases. We analyzed demographic and clinical data, risk factors for dural fistulas, treatment type, peri- and post-operative morbidity, clinical and radiological outcomes, rates of occlusion, and long-term neurological outcome. Sixteen patients (81 % men, mean age of 58 years) with ethmoidal dural fistulas were included in the analysis. Seven patients had suffered an intracranial hemorrhage; the remaining presenting with neurological signs and symptoms or the fistula was an incidental finding. Three patients were managed conservatively. Among patients who underwent intervention (n = 13), 46.1 % were treated with endovascular therapy and 53.9 % were treated surgically. Complete angiographic obliteration was achieved in 100 % immediately after treatment and at last follow-up evaluation. All patients experienced a favorable neurological recovery (mRS 0-2) at the last follow-up visit (12 months). Ethmoidal dural AVFs are found mostly in male patients. Nowadays, due to wider use of non-invasive imaging, AVFs are discovered with increasing frequency in patients with minimal or no symptoms. Traditionally, these fistulas were considered "surgical." However, in the modern endovascular era, selected patients can be effectively and safely treated with embolization although surgical ligation continues to have an important role in their management.
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Cannizzaro
authors.affiliation: Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, Sapienza University of Rome, Viale del policlinico 155, 00100, Rome, Italy. simone.peschillo@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Peschillo
authors.affiliation: Department of Neurosurgery, Niguarda Cà Granda Hospital, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cenzato
authors.affiliation: Department of Radiology, Hospital Niguarda, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Pero
authors.affiliation: Department of Radiology-Neuroradiology, Ospedale SS Annunziata ASL Taranto, Taranto, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Resta
authors.affiliation: Division of Interventional Neuroradiology, Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Guidetti
authors.affiliation: Department of Radiology-Neuroradiology, Ospedale SS Annunziata ASL Taranto, Taranto, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Burdi
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Piccirilli
authors.affiliation: Department of Neurology and Psychiatry, Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Santoro
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, MN, USA.|Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.|Medical School, Mayo Clinic, Rochester, MN, USA.
authors.forename: G
authors.initials: G
authors.lastname: Lanzino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D035262:Cranial Fossa, Anterior / Q000098:blood supply* / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Arteriovenous malformation; Endovascular treatment; Ethmoidal arteriovenous fistula; Surgical disconnection