Transvenous approach: a promising strategy for endovascular treatment of cribriform plate dural arteriovenous fistula

OBJECTIVE Cribriform plate dural arteriovenous fistula (DAVF) is a rare lesion associated with a high risk of bleeding. Transarterial embolization (TAE) has been widely recognized as the first-line treatment. However, limited data exist regarding the safety and efficacy of transvenous embolization (TVE). The aim of this study was to report on a cohort of patients with cribriform plate DAVFs who underwent endovascular treatment (EVT), detailing both clinical and angiographic outcomes. METHODS This single-center case series was conducted from January 2016 to June 2024, including 26 cases in which cribriform plate DAVFs were treated with EVT. A retrospective review of clinical and radiological data was performed. The safety and efficacy of TAE and TVE were compared and further analyzed by including results from the literature published over the past decade. RESULTS A total of 25 patients (mean age 60.2 ± 8.3 years; all male) in 26 cases were included in this study. The immediate postoperative total embolization rates were 53.8% (7/13) and 100% (13/13) for TAE and TVE, respectively, resulting in an overall success rate of 76.9% (20/26). TVE demonstrated a significantly higher success rate than that of TAE (p = 0.015). Three TAE cases had surgical complications, including microcatheter fracture (2/3) and thromboembolism (1/3). The TVE group experienced no symptomatic complications. Similar results were observed in the literature review. CONCLUSIONS TVE might be considered as a preferential strategy for cribriform plate DAVFs in select cases. For optimal safety, it is crucial to navigate microcatheters into the cortical vein using the wire-loop technique. Further studies are required to validate its safety and efficacy.