Diploic arteriovenous fistulas—classification and endovascular management

• Published in: Acta neurochirurgica Vol. 157; no. 9; pp. 1485 - 1488
• Main Authors: Rivera-Lara, Lucia, Gailloud, Philippe, Nyquist, Paul
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.09.2015; Springer Nature B.V
• Subjects: Adult; Aged; Arteriovenous Fistula - classification; Arteriovenous Fistula - diagnosis; Arteriovenous Fistula - surgery; Clinical Article - Vascular; Cranial Sinuses - pathology; Cranial Sinuses - surgery; Female; Humans; Interventional Radiology; Male; Medicine; Medicine & Public Health; Meningeal Arteries - pathology; Meningeal Arteries - surgery; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Surgical Orthopedics; AV fistulas; Treatment of AV fistulas; Classification of diploic AV fistulas; Diploic arteriovenous fistula
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-015-2505-6

Background The authors report on two cases of diploic arteriovenous fistulas (AVFs) in the left parieto-occipital region of a 20-year-old female and the right parietal region of a 68-year-old male. The clinical presentation, angiographic appearance, and endovascular management of these rare lesions are discussed. Methods Retrospective data from two patients with diplopic AVFs are examined with a review of all published cases of diploic arteriovenous fistulas. Results Where previously reported diploic AVFs showed venous drainage to be intracranial or combined, two case studies examined by the authors found exclusively extracranial drainage in the AVFs. In both case studies the lesions were primarily fed by the middle meningeal artery and treated via a transarterial endovascular approach using n-BCA glue. Conclusions After reviewing all reported cases of AVF in the literature and combining our two new observations, we concluded that diploic AVFs can have three types of venous outflow: draining toward dural sinuses only, toward extracranial veins only, and combining the dural and extracranial pathways.