J Cerebrovasc Endovasc Neurosurg.  2015 Sep;17(3):263-267. 10.7461/jcen.2015.17.3.263.

Visual Field Defect after Transfrontal Sinus Approach of Ethmoidal Dural Arteriovenous Fistulas (eDAVFs) : Experience and Complication of Transfrontal Sinus Approach

Affiliations
  • 1Department of Neurosurgery, Gachon University Gil Medical Center, Incheon, Korea. nschan@gilhospital.com

Abstract

The approach to ethmoidal dural arteriovenous fistulas (eDAVFs) is usually via a pterional or a frontal craniotomy. However, the transfrontal sinus is a more direct route to the fistula. The aim of this report is to describe our experience and associated complications occurring as a result of flow diversion in the transfrontal sinus approach for eDAVFs. In this report, we discuss visual field defects occurring after a transfrontal sinus operation. This approach is most direct for surgical treatment of an eDAVF, enabling preservation of neural structures with minimal to no negative effects on the brain. Although the surgery was uneventful, the patient presented with a left side visual field defect. An ophthalmologic exam detected an arterial filling delay in the choroidal membrane and ischemic optic neuropathy was highly suspected. The patient is currently recovering under close observation with no special treatment. The transfrontal sinus approach provides the most direct and shortest route for eDAVFs, while minimizing intraoperative bleeding. However, complications, such as visual field defects may result from a sudden flow diversion or eyeball compression due to scalp traction.

Keyword

Intracranial arteriovenous malformations; Frontal sinus; Surgical procedures; operative; Complications

MeSH Terms

Brain
Central Nervous System Vascular Malformations*
Choroid
Craniotomy
Fistula
Frontal Sinus
Hemorrhage
Humans
Intracranial Arteriovenous Malformations
Membranes
Optic Neuropathy, Ischemic
Scalp
Traction
Visual Fields*

Figure

  • Fig. 1 (A) Axial T1-weighted magnetic resonance imaging showing an enlarged vein at the left frontal lobe; (B) ecstatic left frontal cortical vein (19 mm × 15 mm) compressed brain; (C) magnetic resonance angiography showing vascular malformation, such as arteriovenous malformation on the left frontal lobe.

  • Fig. 2 Digital subtraction angiography. (A) Anteroposterior view of the left internal carotid artery (ICA) and (B) Lateral view of the left ICA: dural arteriovenous fistulas vascularized by the left anterior and posterior ethmoidal arteries originating from the left ophthalmic artery. Diameter of the left ophthalmic artery was 2.13 mm (arrow); (C) Anteroposterior view of the right ICA showing anastomosis arising from the right ophthalmic artery; (D) Lateral view of the right ECA showing anastomosis. The venous drainage through a large vein, which drains into frontal cortical veins, which then drain into the superior sagittal sinus.

  • Fig. 3 (A) Anteroposterior plain film. Size of the frontal sinus is approximately 3.6 cm × 2.7 cm; (B) Perioperative image. Margin of the frontal sinus and large vein is marked using a neuronavigator.

  • Fig. 4 Digital subtraction angiography. (A) Anteroposterior view of the left internal carotid artery (ICA) and (B) Lateral view of the left ICA. Drainage into the large vein is no longer observed and the dural artertiovenous fistula is not present. Diameter of the left ophthalmic artery decreased to 1.10 mm (arrow) as compared to 2.13 mm pre-operation.


Reference

1. Agid R, Terbrugge K, Rodesch G, Andersson T, Soderman M. Management strategies for anterior cranial fossa (ethmoidal) dural arteriovenous fistulas with an emphasis on endovascular treatment. J Neurosurg. 2009; 1. 110(1):79–84. PMID: 18847336.
Article
2. Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg. 1995; 2. 82(2):166–179. PMID: 7815143.
Article
3. Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995; 3. 194(3):671–680. PMID: 7862961.
Article
4. Davies MA, TerBrugge K, Willinsky R, Coyne T, Saleh J, Wallace MC. The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg. 1996; 11. 85(5):830–837. PMID: 8893721.
Article
5. Ducic Y, Coimbra C. Minimally invasive transfrontal sinus approach to resection of large tumors of the subfrontal skull base. Laryngoscope. 2011; 11. 121(11):2290–2294. PMID: 22020880.
Article
6. Halbach VV, Higashida RT, Hieshima GB, Wilson CB, Barnwell SL, Dowd CF. Dural arteriovenous fistulas supplied by ethmoidal arteries. Neurosurgery. 1990; 5. 26(5):816–823. PMID: 2191241.
Article
7. Hashiguchi A, Mimata C, Ichimura H, Morioka M, Kuratsu J. Venous aneurysm development associated with a dural arteriovenous fistula of the anterior cranial fossa with devastating hemorrhage-case report. Neurol Med Chir (Tokyo). 2007; 2. 47(2):70–73. PMID: 17317944.
Article
8. Hoh BL, Choudhri TF, Connolly ES Jr, Solomon RA. Surgical management of high-grade intracranial dural arteriovenous fistulas: leptomeningeal venous disruption without nidus excision. Neurosurgery. 1998; 4. 42(4):796–804. discussion 804-5PMID: 9574644.
Article
9. Im SH, Oh CW, Han DH. Surgical management of an unruptured dural arteriovenous fistula of the anterior cranial fossa: natural history for 7 years. Surg Neurol. 2004; 7. 62(1):72–75. discussion 75PMID: 15226079.
Article
10. Jimbo H, Ikeda Y, Izawa H, Otsuka K, Haraoka J. Mixed pial-dural arteriovenous malformation in the anterior cranial fossa--two case reports. Neurol Med Chir (Tokyo). 2010; 50(6):470–475. PMID: 20587971.
11. Kakarla UK, Deshmukh VR, Zabramski JM, Albuquerque FC, McDougall CG, Spetzler RF. Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications. Neurosurgery. 2007; 9. 61(3):447–457. discussion 457-9PMID: 17881955.
12. Kohama M, Nishimura S, Mino M, Hori E, Yonezawa S, Kaimori M, et al. Anterior cranial fossa dural arteriovenous fistula with bilateral cortical drainers-case report. Neurol Med Chir (Tokyo). 2010; 50(3):217–220. PMID: 20339271.
13. Lasjaunias P, Chiu M, ter Brugge K, Tolia A, Hurth M, Bernstein M. Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg. 1986; 5. 64(5):724–730. PMID: 3701421.
Article
14. Lawton MT, Chun J, Wilson CB, Halbach VV. Ethmoidal dural arteriovenous fistulae: an assessment of surgical and endovascular management. Neurosurgery. 1999; 10. 45(4):805–810. discussion 810-1PMID: 10515474.
Article
15. Liu JK, Dogan A, Ellegala DB, Carlson J, Nesbit GM, Barnwell SL, et al. The role of surgery for high-grade intracranial dural arteriovenous fistulas: importance of obliteration of venous outflow. J Neurosurg. 2009; 5. 110(5):913–920. PMID: 19199500.
Article
16. Magro E, Engel D, Bojanowski MW. Transfrontal sinus approach for an anterior cranial fossa, ethmoidal, dural arteriovenous fistula. Surg Neurol Int. 2014; 12. 5:172. PMID: 25593756.
Article
17. Maier P, Feltgen N, Lagrèze WA. Bilateral orbital infarction syndrome after bifrontal craniotomy. Arch Ophthalmol. 2007; 3. 125(3):422–423. PMID: 17353420.
Article
18. Riva CE, Titze P, Hero M, Petrig BL. Effect of acute decreases of perfusion pressure on choroidal blood flow in humans. Invest Ophthalmol Vis Sci. 1997; 8. 38(9):1752–1760. PMID: 9286263.
19. Soderman M, Pavic L, Edner G, Holmin S, Andersson T. Natural history of dural arteriovenous shunts. Stroke. 2008; 6. 39(6):1735–1739. PMID: 18388337.
Article
20. Suzuki J, Mizoi K, Yoshimoto T. Bifrontal interhemispheric approach to aneurysms of the anterior communicating artery. J Neurosurg. 1986; 2. 64(2):183–190. PMID: 3944627.
21. Tanei T, Fukui K, Wakabayashi K, Mitsui Y, Inoue N, Watanabe M. Dural arteriovenous fistula in the anterior cranial fossa: four case reports. Neurol Med Chir (Tokyo). 2008; 12. 48(12):560–563. PMID: 19106494.
22. van Dijk JM, terBrugge KG, Willinsky RA, Wallace MC. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke. 2002; 5. 33(5):1233–1236. PMID: 11988596.
Article
23. Yakes WF, Krauth L, Ecklund J, Swengle R, Dreisbach JN, Seibert CE, et al. Ethanol endovascular management of brain arteriovenous malformations: initial results. Neurosurgery. 1997; 6. 40(6):1145–1152. discussion 1152-4PMID: 9179886.
Article
24. Zhao WY, Krings T, Yang PF, Liu JM, Xu Y, Li Q, et al. Balloon-assisted superselective microcatheterization for transarterial treatment of cranial dural arteriovenous fistulas: technique and results. Neurosurgery. 2012; 12. 71(2 Suppl Operative):ons269–ons273. discussion ons273PMID: 22791037.
Full Text Links
  • JCEN
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr