{"id":"06f38779-ae20-47e9-b93d-fc6ee4223007","slug":"transarterial-embolization-for-anterior-cranial-fossa-dural-arteriovenous-fistula-based-on-multi-modal-three-dimensional-imaging","title":"Transarterial embolization for anterior cranial fossa dural arteriovenous fistula based on multi-modal three-dimensional imaging","authors":["Masashi Kotsugi","Kengo Konishi","Shohei Yokoyama","Ai Okamoto","Kenta Nakase","Ryosuke Maeoka","Ryosuke Matsuda","Ichiro Nakagawa"],"abstract":"Background: Dural arteriovenous fistula (DAVF) in the anterior cranial fossa (ACF) is known to show a high risk of intracranial hemorrhage. Recently, multi-modal fusion imaging with computed tomography angiography, computed tomography venography, and three-dimensional (3D) rotation angiography have been used preoperatively to ensure anatomical safety. We report on endovascular treatment as a first-line approach for ACFDAVF based on the understanding of vascular anatomy obtained from multi-modal fusion imaging. Methods: All patients with ACF-DAVF treated endovascularly as a first-line approach were included in this study. Analyses took into account complications (particularly visual function), immediate angiographic outcomes, and follow-up findings in consecutive patients with ACF-DAVF treated with interventional treatment based on multi-modal fusion imaging. Results: Five patients with ACF-DAVF underwent six sessions of transarterial embolization (TAE) in our institution. The five male patients (mean age, 74.5 years; range, 60–84 years) were treated with liquid embolic agents (Onyx, four procedures; n-butyl 2-cyanoacrylate, two procedures). No difference was seen between preoperative image evaluation and image evaluation during the endovascular procedure, and in all cases, a microcatheter was navigated into a target artery assumed from preoperative multi-modal imaging, allowing treatment completion in a single procedure. In all cases, the shunt disappeared completely and visual function after procedure was maintained. At the last follow-up, all patients showed a modified Rankin scale score of 0 or 1 with no recurrences. Conclusion: Multi-modal fusion imaging facilitates a 3D understanding of the vascular anatomy, allowing TAE as the first-line treatment for ACF-DAVF.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/06f38779-ae20-47e9-b93d-fc6ee4223007/featured/hero-1781559142262.png","publishDate":"2024-10-25T00:00:00.000Z","doi":"10.25259/SNI_698_2024","categories":["Neurovascular","Technical Note"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2024/10/13161/SNI-15-386.pdf"}