An Endovascular Venous Access and Its Role in Neurosurgical Treatment of Cerebrovascular Pathology

S.B. Yakovlev, A.V. Bocharov, E.Yu. Buharin, S.R. Arustamyan, P.S. Dorohov, Ya.N. Arhangelskaya

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

Neuroendovascular interventions with applying a venous access (VA) are an effective means of treatment of some types of cerebrovascular pathology. However, experience of its use is rather small and existing methods and algorithms demand further development. The study goal has been to summarize results of treatment of neurovascular pathology, carried out under conditions of one clinic.

Material and Methods. There were 100 cases, operated in 2002-2008; a number of operations, performed with the help of VA, was 169. There were 48 males and 52 females, aged 1.3-78. Pathology distribution was as follows: dural arteriovenous fistulas (DAVF) - 57 cases (57%), arteriovenous fistulas proper (AVF) – 22 (22%), AVM of Galen’s vein – 3 (3%), sinus thromboses – 9 (9%), craniofacial hemangiomas – 6 (6%), other diseases – 3 (3%). Isolated VA was performed in 70 cases; a combined approach was used in the rest patients. Transfemoral VA was possible in the majority of cases; it was direct in 6 cases (superior ophthalmic and facial veins, puncture of the sigmoid sinus).

Results. Angiographic examination revealed total, subtotal and partial disconnection of AVF in 74%, 17% and 9%, respectively. As for thrombosis and sinus stenosis, complete recanalization was achieved with the help of local thrombolytic therapy and balloon sinusoplasty. Total occlusion of venous cavities was performed in 2 cases with varicosis of orbital veins. Rates of invalidism and mortality were 1% and 1%, respectively.

Conclusion. Transvenous occlusion is an effective method of DAVF treatment. Combined (transarterial and transvenous) methods of disconnection provide improvement of results in treatment of AVF proper. The method, based on VA, demands further development and should be used more widely in clinical practice.