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


Neurosurg Focus. 2006;20(6) 

In This Article


The impact of the technical advances described in this paper is revealed by the improved diagnosis and successful endovascular treatment of nongalenic cerebral AVFs. From 1928 to the present, more than 47 adults and children with nongalenic AVFs have been described, either in individual case reports or in case series, with open surgery the only possible treatment in early cases.[2,3,4,5,6,8,11,15,17,21,25,27,31,35,36,37,38,40,42] In the modern era, there remain certain nongalenic AVFs that are best approached in open surgery for anatomical reasons. Also, practitioners today sometimes still hesitate to treat nongalenic cerebral AVFs with endovascular embolization due to the danger of embolic material migrating into the lungs, cortical veins, or dural venous sinuses be cause of the lesions' high flow.[27,38] However, the technological progress in interventional neuroradiology made over the past four decades currently supports many different strategies to reduce flow during endovascular treatment and to avoid this risk. Due to such technical innovations, the success rate of interventional neuroradiological treatment has improved dramatically, and it is now the optimal treatment approach for many nongalenic AVFs. On this basis, endovascular embolization is currently established as an important alternative to open surgery for the treatment of nongalenic AVFs.


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