Coil-based endovascular treatment of single-hole cerebral arteriovenous fistulae: experiences in 11 patients

World Neurosurg. 2010 Jan;73(1):2-10; discussion e1. doi: 10.1016/j.surneu.2009.06.001. Epub 2009 Aug 7.


Background: An SHF is rare pial arteriovenous shunt with no nidal component, of which the feeder drains directly into a single venous channel. Casting with NBCA was described previously, but its control demands operator to accumulate a considerable learning curve. We are to present our experiences of coil-based endovascular treatment of SHF.

Methods: Eleven patients harbored 12 SHFs (5 men, 6 women; mean age, 28.4 years; age range, 4-73 years), and they presented with hemorrhage, seizure, collapse, orbital mass, and as an incidental lesion. The location was frontal for 3, temporal for 5, parietal in 2, and occipital in 2 patients. The angioarchitectures, the methods of endovascular treatment, and outcomes were analyzed.

Results: Fifteen feeders arose from 4 anterior, 8 middle, and 3 posterior cerebral arteries. The coil framework was constructed at the fistula before the penetration of a low concentrated NBCA. Nine fistulae were occluded completely, and 3 fistulae were occluded to near-completion with micro-AVM. There was no recanalization of SHF, either growth of a micro-AVM during follow-up period (mean, 48.3 months; range, 6-120 months). One patient with postprocedure hemorrhage developed hemiplegia, but 1 patient with seizure and the other 9 asymptomatic patients were uneventful.

Conclusions: The coil-based endovascular treatment can achieve safe and stable occlusion of SHF, and the preventions against venous thrombosis and perfusion breakthrough should be essential.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Angioplasty*
  • Arteriovenous Fistula / complications
  • Arteriovenous Fistula / pathology
  • Arteriovenous Fistula / therapy*
  • Cerebral Hemorrhage / etiology
  • Cerebral Hemorrhage / pathology
  • Cerebral Hemorrhage / therapy*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Embolization, Therapeutic*
  • Female
  • Humans
  • Intracranial Arteriovenous Malformations / complications
  • Intracranial Arteriovenous Malformations / pathology
  • Intracranial Arteriovenous Malformations / therapy*
  • Male
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult