Alternative management considerations for ethmoidal dural arteriovenous fistulas

Surg Neurol. 2002 Dec;58(6):410-6; discussion 416. doi: 10.1016/s0090-3019(02)00871-6.


Background: Ethmoidal dural arteriovenous fistulas (EDAFs) are an unusual type of intracranial vascular lesion that commonly present with acute hemorrhage. They are often best treated surgically; however, recent endovascular advances raise questions concerning the best therapeutic approach.

Methods: We present 7 cases of EDAFs managed at this institution over a 6-year period, which demonstrate the broad spectrum of clinical behavior associated with the lesions. Four patients presented with intracranial hemorrhage, 1 patient with rapidly progressive dementia, 1 patient with a proptotic, red eye, and 1 with a retro-orbital headache.

Results: One patient underwent no treatment, 1 underwent embolization alone, 2 underwent embolization and resection, and 3 patients underwent resection alone. There was complete obliteration of the EDAF in all of the patients who underwent surgical resection. Embolization was performed through the external carotid circulation and not the ophthalmic artery. There were no treatment-related neurologic deficits.

Conclusions: Treatment is best managed with a multidisciplinary approach, which emphasizes complete resection of the lesions with assistance from interventional neuroradiology techniques. However, each patient must be evaluated independently as treatment may vary depending on the angioarchitecture of the lesion.

Publication types

  • Review

MeSH terms

  • Aged
  • Central Nervous System Vascular Malformations / diagnostic imaging
  • Central Nervous System Vascular Malformations / therapy*
  • Cranial Fossa, Anterior / blood supply
  • Cranial Fossa, Anterior / diagnostic imaging
  • Cranial Fossa, Anterior / surgery
  • Embolization, Therapeutic*
  • Ethmoid Bone / blood supply*
  • Ethmoid Bone / diagnostic imaging
  • Ethmoid Bone / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures
  • Radiography