Abstract
Arturs Shilovs, Katrina Kupca, Helmuts Kidikas, Karlis Kupcs. Department of Interventional Radiology, Paul Stradins UniversityHospital,Riga, Latvia,Riga, Latvia
10.1136/jnis-2025-ESMINT.231
Introduction Cribriform plate arteriovenous fistulas (AVFs) are rare vascular anomalies associated with headaches, pulsatile tinnitus and anosmia. Patients frequently report history of head trauma. Limited data exist on their optimal management. This case series evaluates the efficacy of transvenous embolization for durable fistula occlusion. Case Description Three patients (females, aged 52, 63 and 68) with unruptured cribriform plate AVF were included in this review. 2/3 patients had a history of head treauma. 2/3 patients presented with nonspecific headache, 1/3 patient had a seizure one year after traumatic event. Digital subtraction angiography (DSA) confirmed cribriform plate AVFs fed by
ethmoidal arteries and drained via anterior cranial fossa veins, mainly into superior sagittal sinus (SST). Transarterial route did not allow to reach fistula point in one patient, followed with successful transvenous approach. Other patients were primarly treated with transvenous embolization via the SST, using pressure cooker technique – detachable coils trapping microcatheter followed by Onyx 18 injection to occlude the fistulous point. All procedures were completed without complications. Post-procedural DSA demonstrated complete fistula obliteration in one case with other two scheduled for follow-up later. Patients noted symptom resolution the following day in all cases. Conclusions Transvenous embolization using coils and Onyx18 system is safe and effective treatment for cribriform plate AVFs, achieving durable occlusion and symptom resolution. This approach minimizes the risk of occluding central retinal artery, as well as ciliary arteries, while addressing the unique anatomic challenges of this region. In our opinion early intervention is critical for symptom resolution and avoidance of further complications. Conflict of Interest N
10.1136/jnis-2025-ESMINT.231
Introduction Cribriform plate arteriovenous fistulas (AVFs) are rare vascular anomalies associated with headaches, pulsatile tinnitus and anosmia. Patients frequently report history of head trauma. Limited data exist on their optimal management. This case series evaluates the efficacy of transvenous embolization for durable fistula occlusion. Case Description Three patients (females, aged 52, 63 and 68) with unruptured cribriform plate AVF were included in this review. 2/3 patients had a history of head treauma. 2/3 patients presented with nonspecific headache, 1/3 patient had a seizure one year after traumatic event. Digital subtraction angiography (DSA) confirmed cribriform plate AVFs fed by
ethmoidal arteries and drained via anterior cranial fossa veins, mainly into superior sagittal sinus (SST). Transarterial route did not allow to reach fistula point in one patient, followed with successful transvenous approach. Other patients were primarly treated with transvenous embolization via the SST, using pressure cooker technique – detachable coils trapping microcatheter followed by Onyx 18 injection to occlude the fistulous point. All procedures were completed without complications. Post-procedural DSA demonstrated complete fistula obliteration in one case with other two scheduled for follow-up later. Patients noted symptom resolution the following day in all cases. Conclusions Transvenous embolization using coils and Onyx18 system is safe and effective treatment for cribriform plate AVFs, achieving durable occlusion and symptom resolution. This approach minimizes the risk of occluding central retinal artery, as well as ciliary arteries, while addressing the unique anatomic challenges of this region. In our opinion early intervention is critical for symptom resolution and avoidance of further complications. Conflict of Interest N
| Original language | English |
|---|---|
| Article number | C81 |
| Number of pages | 1 |
| Journal | Journal of NeuroInterventional Surgery |
| Volume | 17 |
| Issue number | Suppl.2 |
| Publication status | Published - Sept 2025 |
| Externally published | Yes |
| Event | 17th Congress of the European Society of Minimally Invasive Neurological Therapy (ESMINT) - Marseille, France Duration: 3 Sept 2025 → 5 Sept 2025 Conference number: 17 |
Keywords*
- dural fistula
Field of Science*
- 3.2 Clinical medicine
Publication Type*
- 3.4. Other publications in conference proceedings (including local)