Journal article
Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation
Journal of neurosurgery, Vol.136(4), pp.971-980
09/10/2021
DOI: 10.3171/2021.1.JNS202861
PMID: 34507300
Abstract
There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system.
The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non-flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected.
Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%).
Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%-5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.
Details
- Title: Subtitle
- Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation
- Creators
- Isaac Josh Abecassis - Departments of1Neurological SurgeryR Michael Meyer - Departments of1Neurological SurgeryMichael R Levitt - University of WashingtonJason P Sheehan - University of Virginia Health SystemChing-Jen Chen - University of Virginia Health SystemBradley A Gross - University of PittsburghAshley Lockerman - University of FloridaW Christopher Fox - University of FloridaWaleed Brinjikji - 9Radiology, Mayo Clinic, Rochester, MinnesotaGiuseppe Lanzino - 9Radiology, Mayo Clinic, Rochester, MinnesotaRobert M Starke - University of MiamiStephanie H Chen - University of MiamiAdriaan R E Potgieser - University Medical Center GroningenJ Marc C van Dijk - University Medical Center GroningenAndrew Durnford - University of SouthamptonDiederik Bulters - University of SouthamptonJunichiro Satomi - 13Department of Neurosurgery, Tokushima University, Tokushima, JapanYoshiteru Tada - 13Department of Neurosurgery, Tokushima University, Tokushima, JapanAmanda Kwasnicki - University of Illinois ChicagoSepideh Amin-Hanjani - University of Illinois ChicagoAli Alaraj - University of Illinois ChicagoEdgar A Samaniego - University of IowaMinako Hayakawa - University of IowaColin P Derdeyn - University of IowaEthan Winkler - University of California, San FranciscoAdib Abla - University of California, San FranciscoPui Man Rosalind Lai - Brigham and Women's HospitalRose Du - Brigham and Women's HospitalRidhima Guniganti - Departments of18Neurological SurgeryAkash P Kansagra - 20Neurology, Washington University School of Medicine, St. Louis, MissouriGregory J Zipfel - Departments of18Neurological SurgeryLouis J Kim - University of WashingtonConsortium for Dural Arteriovenous Fistula Outcomes Research
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery, Vol.136(4), pp.971-980
- DOI
- 10.3171/2021.1.JNS202861
- PMID
- 34507300
- NLM abbreviation
- J Neurosurg
- eISSN
- 1933-0693
- Language
- English
- Date published
- 09/10/2021
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984230417202771
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