Nongalenic Arteriovenous Fistulas: History of Treatment and Technology

Kristen Upchurch, MD; Lei Feng, MD, PhD; Gary R. Duckwiler, MD; John G. Frazee, MD; Neil A. Martin, MD; Fernando Viñuela, MD

Disclosures

Neurosurg Focus. 2006;20(6) 

In This Article

Abstract and Introduction

Abstract

Nongalenic cerebral arteriovenous fistulas (AVFs) are uncommon, high-flow vascular lesions first treated by Walter Dandy and his colleagues by using open surgery with ligation of the feeding artery. Due to advances in endovascular technology over the past four decades that make possible the control of high flow in AVFs, treatment has evolved from the sole option of surgery to include the alternative or adjunct option of endovascular embolization. The authors of this review discuss the history of nongalenic AVF treatment, including techniques of both surgery and interventional neuroradiology and the technological developments underlying them.

Introduction

Arteriovenous fistulas consist of a direct high-flow connection between an artery and a vein without an intervening nidus.[1,8,21,36] Arteriovenous fistulas termed "nongalenic" are uncommon vascular malformations that do not involve a persistent embryonic median prosencephalic vein; they are called nongalenic because they are a class of lesion separate from so-called vein of Galen aneurysms or malformations. In this article we first describe the historical classification, anatomy, and clinical features of nongalenic AVFs as background and then we focus on the history of their treatment. This history is necessarily recent, given the emphasis on innovations in endovascular technology that have improved the ability to diagnose nongalenic AVFs and expanded options for their treatment.

The treatment of nongalenic AVFs has changed dramatically during the past several decades due to technical advances. From the early days of neurosurgery to the 1960s, nongalenic AVFs were treated only with open surgery. As new technology has improved the potential for endovascular control over these lesions' high flow, embolization performed by interventional neuroradiologists has become an accepted treatment, either alone or combined with surgery or stereotactic radiosurgery. The history of treatment for nongalenic cerebral AVFs is discussed in this paper in terms of technological progress—from the sole option of open surgery in the early era of treatment to the present-day adjunct and alternative option of endovascular therapy.

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