Article Figures & Data
Figures
- FIG 1.
A patient with 2 dAVFs with separate arterial feeders and venous drainage. A right-sided injection of the ICA shows a dAVF with supply from the right ophthalmic artery with drainage through a dilated cortical vein on the left side (arrow) into the superior sagittal sinus (A and B). After successful embolization through 1 of the 2 ethmoidal branches of the left ophthalmic artery (C), a repeat right ICA injection clearly shows the second remaining fistula with separate transethmoidal supply refluxing into a nondilated vein on the right-sided cortical frontal vein (arrowheads) into the superior sagittal sinus. The bayonet sign is seen, signifying the origin of the central retinal artery (white arrowhead, D and E). Because the first embolization was performed without substantial arterial reflux, the second fistula was again successfully embolized through the right ophthalmic artery (F).
- FIG 2.
A patient who presented with transient aphasia. Angiography demonstrated a dAVF with arterial feeding through ethmoidal branches of the right ophthalmic artery in a posterior-anterior projection (A), the left ophthalmic artery in a lateral projection (arrowheads) (B), and the frontal branch of the left middle meningeal artery (not shown). Cortical venous reflux is seen through ectatic left-sided cortical veins (arrow) toward the superficial middle cerebral vein before ending in the sigmoid sinus (A and B). Embolization through the right ophthalmic artery, with filling of the proximal refluxing vein with a minor spill of glue in the more distal venous territory (C). Complete occlusion of the fistula was achieved. The bayonet sign is seen, signifying the origin of the central retinal artery (white arrow) (D). The patient was asymptomatic at follow-up.
- FIG 3.
A patient with a complex dAVF with extensive arterial supply from both ophthalmic arteries (arrow), right middle meningeal artery (arrowhead), and infraorbital branch from the maxillary artery (white arrowhead). Due to proximal elongation, the exact location of the bayonet cannot be determined (A and B). Multiple venous ectasias are visible along the cortical draining vein (white arrows). Embolization was attempted through both ophthalmic arteries, which had to be halted due to reflux before glue could reach the venous outlet. The patient finally underwent surgery, with successful disconnection of the fistula.
Tables
Treatment characteristics
Variable Value (%) (No.) Primary endovascular treatment 100% (14/14) Transarterial 86% (12/14) Transvenous 7% (1/14) Combined 7% (1/14) Secondary surgery after failed endovascular treatment 21% (3/14) Endovascular outcome Complete occlusion 79% (11/14) Partial occlusion 7% (1/14) No embolization attempt 14% (2/14) Clinical outcomea Asymptomatic 29% (4/14) Improvement of symptoms 71% (10/14) Worsening of symptoms 0% (0/14) Death 0% (0/14) Procedural complications Endovascular treatment 0% (0/14) Surgery 67% (2/3) Seizure 33% (1/3) Anosmia 33% (1/3) ↵a This concerns symptoms attributed to the dAVF.
