Ahead of Print: Spinal Pial (Type IV) Arteriovenous Fistulae

Background: Demographics, hemorrhage risk, and results of surgical and endovascular treatment of spinal pial (Type IV) arteriovenous fistulae (AVF) across a large patient group have not been previously reported.

Objective: To report demographics, hemorrhage rates, and treatment results for these AVF.

Methods: We performed a pooled analysis via the PubMed and Embase databases through November 2012. Individualized patient data were extracted and analyzed using Cox proportional hazards regression to obtain hazard ratios for hemorrhage risk factors and pooled for baseline demographics and treatment results.

Free CME Editor Choice Article: Intraoperative Angiography in Craniotomies

Background: In an era of indocyanine angiography, the routine use of intraoperative angiography (IOA) in the surgical treatment of aneurysms and vascular malformations is controversial.

Objective: To retrospectively assess the safety and efficacy of IOA and to determine predictors of surgical revision.

Methods: Between 2003 and 2011, IOA was performed during surgical treatment of 976 aneurysms, 101 arteriovenous malformations (AVMs), and 16 arteriovenous fistulas.

Ahead of Print: Transvenous Embolization of Orbital AVF

Background and Importance: Purely intraorbital arteriovenous fistulas (AVFs), which are rare vascular malformations that clinically mimic carotid-cavernous fistulas (CCFs), involve a fistula from the ophthalmic artery to one of the draining ophthalmic veins. We describe a case of an intraorbital AVF treated with transvenous endovascular coil embolization via the inferior petrosal sinus (IPS) route and review the literature on this rare entity.

Clinical Presentation: An 81-year-old woman sought treatment after 7 days of progressive left-sided visual acuity loss, chemosis, and lateral rectus palsy. Magnetic resonance imaging demonstrated dilated vascularity in the left orbit raising suspicions for a CCF. Cerebral angiography showed a purely intraorbital AVF with a fistula between the left ophthalmic artery and superior ophthalmic vein (SOV). Transvenous selective catheterization of the fistula was performed by successfully navigating the ipsilateral IPS to the cavernous sinus and SOV. The fistula was then embolized using detachable coils. The patient was discharged the next day. Three weeks after embolization, her ocular symptoms and findings had resolved.

Free CME Article: Safety of Pediatric Onyx Embolization

Background: Although Onyx is widely used to embolize vascular lesions in adults, the safety and efficacy of this liquid embolic agent for use in children are not well studied.

Objective: To report our experience using Onyx in pediatric patients for a variety of cranial and spinal vascular lesions and tumors to determine its procedural complication rates, types, and clinical consequences and to highlight the indications for and principles of Onyx embolization in pediatric patients.

Methods: All pediatric Onyx embolization cases performed consecutively by the neuroendovascular services at our 2 institutions over a 5-year period were collected retrospectively and analyzed.

Ahead of Print: Cerebral Dural Arteriovenous Fistulae Natural History

Background: Hemorrhage from cerebral dural arteriovenous fistulae (dAVF) is a considerable source of neurologic morbidity and even mortality.

Objective: To evaluate the natural history of cerebral dAVF.

Methods: We reviewed our own cohort of 70 dAVF and incorporated results from the literature, synthesizing pooled hemorrhage rates and evaluating risk factors for 395 dAVF in 6 studies.