P-009 Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

S Sanchez; A Raghuram; L Wendt; M Hayakawa; C Chen; J Sheehan; L Kim; I Abecassis; M Levitt; K Jayaraman; R Guniganti; A Kansagra; G Lanzino; E Giordan; W Brinjikji; D Bulters; A Durnford; C Fox; A Polifka; B Gross; S Amin-Hanjani; A Alaraj; A Kwasnicki; R Starke; S Sur; M van Dijk; A Potgieser; J Satomi; Y Tada; A Abla; E Winkler; R Du; P Rosalind Lai; G Zipfel; C Derdeyn; E Samaniego

doi:10.1136/neurintsurg-2022-SNIS.81

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P-009 Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

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P-009 Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

S Sanchez, A Raghuram, L Wendt, M Hayakawa, C Chen, J Sheehan, L Kim, I Abecassis, M Levitt, K Jayaraman, …

Journal of neurointerventional surgery, Vol.14(Suppl 1), pp.A53-A54

07/23/2022

DOI: 10.1136/neurintsurg-2022-SNIS.81

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Abstract

IntroductionAnterior cranial fossa dural arteriovenous fistulas (ACF-dAVFs) have a high risk of rupture. The most important determinant of symptoms and risk of hemorrhage is the pattern of venous drainage. The absence of major venous sinuses in the anterior cranial fossa leads to drainage through delicate small cortical veins that can easily bleed. We present a comprehensive analysis of natural history, angiographic presentation, and outcomes of a large cohort of ACF-dAVFs from the CONDOR database.MethodThe CONDOR consortium is a repository that contains data from 1077 dural arteriovenous fistulas (dAVF) diagnosed in 12 international centers. The consortium includes patients that were diagnosed with dAVFs from 1990 to 2017. dAVFs were classified into various groups depending on the anatomical location. Data from ACF-dAVFs was analyzed from the CONDOR repository.ResultsA total of 60 ACF-dAVFs were included. The mean age was 61±12 and 63% (38/60) were male. Sixty-three percent (38/60) of ACF-dAVF had a symptomatic presentation. Intracranial hemorrhage was the most common presentation 58% (22/38). The ethmoidal artery was the most common arterial feeder (66%, 40/60). Instead of draining directly to a sinus, most ACF-dAVFs (93%, 56/60) drained through cortical veins. Drainage through small cortical veins predicted symptomatic onset (OR 9.42, CI 1.98–69.1, p=0.01) (table 1). Ultimately, most ACF-dAVFs with cortical venous drainage, drained into the superior sagittal sinus (60%, 34/56). Signs of venous ectasia were present in 53% (32/60) of patients. Eighty-eight percent (53/60) of ACF-dAVFs were treated. Microsurgery was the most successful modality of treatment achieving fistula closure in all cases (n=35). Obliteration of the ACF-dAVF was achieved in 53% (9/17) of endovascular interventions. Radiosurgery was attempted without success in one patient. None of the untreated patients had improvement of symptoms and 57% (4/7) had worsening of symptoms at follow up. In contrast, 60% (15/25) of the treated symptomatic patients had complete resolution of symptoms and none had worsening of symptoms at follow up.ConclusionMost symptomatic ACF-dAVFs present with hemorrhage. Cortical venous drainage is a key angio-architecture feature of ACF-dAVFs that accounts for their aggressive presentation. Microsurgery is more effective that other strategies for managing ACF-dAVFs. The analysis of this large cohort of ACF-dAVFs suggests that treatment is warranted at the time of diagnosis, independently of symptomatic status.Abstract P-009 Table 1Univariate logistic regressions to predict symptomatic presentation Characteristics OR 95% CI p-value Age 1.01 0.97, 1.06 0.642 Gender 0.84 0.29, 2.51 0.755 Anticoagulant use 0.57 0.02, 14.9 0.694 Diabetes 2.26 0.49, 16.2 0.339 Presence of venous ectasia 0.69 0.23, 1.99 0.497 Absence of direct sinus drainage 9.42 1.98, 69.1 0.010* Disclosures S. Sanchez: None. A. Raghuram: None. L. Wendt: None. M. Hayakawa: None. C. Chen: None. J. Sheehan: None. L. Kim: None. I. Abecassis: None. M. Levitt: None. K. Jayaraman: None. R. Guniganti: None. A. Kansagra: None. G. Lanzino: None. E. Giordan: None. W. Brinjikji: None. D. Bulters: None. A. Durnford: None. C. Fox: None. A. Polifka: None. B. Gross: None. S. Amin-Hanjani: None. A. Alaraj: None. A. Kwasnicki: None. R. Starke: None. S. Sur: None. M. van Dijk: None. A. Potgieser: None. J. Satomi: None. Y. Tada: None. A. Abla: None. E. Winkler: None. R. Du: None. P. Rosalind Lai: None. G. Zipfel: None. C. Derdeyn: None. E. Samaniego: None.

SNIS 19th annual meeting oral poster abstracts

Details

Title: Subtitle: P-009 Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas
Creators: S Sanchez - University of Iowa
A Raghuram - University of Iowa
L Wendt - Institute for Clinical and Translational Science, The University of Iowa, Iowa City, IA
M Hayakawa - University of Iowa
C Chen - University of Virginia Health System
J Sheehan - University of Virginia Health System
L Kim - University of Washington
I Abecassis - University of Washington
M Levitt - University of Washington
K Jayaraman - Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO
R Guniganti - Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO
A Kansagra - Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO
G Lanzino - Department of Neurosurgery, Mayo Clinic, Rochester, MN
E Giordan - Department of Neurosurgery, Mayo Clinic, Rochester, MN
W Brinjikji - Department of Neurosurgery, Mayo Clinic, Rochester, MN
D Bulters - University of Southampton
A Durnford - University of Southampton
C Fox - Department of Neurosurgery, University of Florida, Gainsville, FL
A Polifka - Department of Neurosurgery, University of Florida, Gainsville, FL
B Gross - University of Pittsburgh
S Amin-Hanjani - University of Illinois Chicago
A Alaraj - University of Illinois Chicago
A Kwasnicki - University of Illinois Chicago
R Starke - University of Miami
S Sur - University of Miami
M van Dijk - University of Groningen
A Potgieser - University of Groningen
J Satomi - Tokushima University
Y Tada - Tokushima University
A Abla - University of California, San Francisco
E Winkler - University of California, San Francisco
R Du - Brigham and Women's Hospital
P Rosalind Lai - Brigham and Women's Hospital
G Zipfel - Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO
C Derdeyn - University of Iowa
E Samaniego - University of Iowa
Resource Type: Abstract
Publication Details: Journal of neurointerventional surgery, Vol.14(Suppl 1), pp.A53-A54
DOI: 10.1136/neurintsurg-2022-SNIS.81
ISSN: 1759-8478
eISSN: 1759-8486
Publisher: BMJ Publishing Group Ltd
Language: English
Date published: 07/23/2022
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984277452802771

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