Journal article
Borden-Shucart Type I dural arteriovenous fistulas: clinical course including risk of conversion to higher-grade fistulas
Journal of neurosurgery, Vol.117(3), pp.539-545
2012
DOI: 10.3171/2012.5.JNS111257
PMID: 22725983
Abstract
Object: The goal of this study was to determine the clinical course of Borden-Shucart Type I cranial dural arteriovenous fistulas (DAVFs) and to calculate the annual rate of conversion of these lesions to more aggressive fistulas that have cortical venous drainage (CVD).
Methods: A retrospective chart review was conducted of all patients harboring DAVFs who were seen at the authors' institution between 1997 and 2009. Twenty-three patients with Type I DAVFs who had available clinical follow-up were identified. Angiographic and clinical data from these patients were reviewed. Neurological outcome and status of presenting symptoms were assessed during long-term follow-up.
Results: Of the 23 patients, 13 underwent endovascular treatment for intolerable tinnitus or ophthalmological symptoms, and 10 did not undergo treatment. Three untreated patients died of unrelated causes. In those who were treated, complete DAVF obliteration was achieved in 4 patients, and palliative reduction in DAVF flow was achieved in 9 patients. Of the 19 patients without radiographic cure, no patient developed intracranial hemorrhage or nonhemorrhagic neurological deficits (NHNDs), and no patient died of DAVF-related causes over a mean follow-up of 5.6 years. One patient experienced a spontaneous, asymptomatic obliteration of a partially treated DAVF in late follow-up, and 2 patients experienced a symptomatic conversion of their DAVF to a higher-grade fistula with CVD in late follow-up. The annual rate of conversion to a higher-grade DAVF based on Kaplan-Meier cumulative event-free survival analysis was 1.0%. The annual rate of intracranial hemorrhage, NHND, and DAVF-related death was 0.0%.
Conclusions: A small number of Type I DAVFs will convert to more aggressive DAVFs with CVD over time. This conversion to a higher-grade DAVF is typically heralded by a change in patient symptoms. Follow-up vascular imaging is important, particularly in the setting of recurrent or new symptoms.
Details
- Title: Subtitle
- Borden-Shucart Type I dural arteriovenous fistulas: clinical course including risk of conversion to higher-grade fistulas
- Creators
- Manish N SHAH - Department of Neurological Surgery, Washington University School of Medicine in St. Louis, Missouri, United StatesJames A BOTROS - Department of Neurological Surgery, Washington University School of Medicine in St. Louis, Missouri, United StatesThomas K PILGRAM - Department of Radiology, and, Washington University School of Medicine in St. Louis, Missouri, United StatesChristopher J MORAN - Department of Neurological Surgery, Washington University School of Medicine in St. Louis, Missouri, United StatesDewitte T CROSS - Department of Neurological Surgery, Washington University School of Medicine in St. Louis, Missouri, United StatesMichael R CHICOINE - Department of Neurological Surgery, Washington University School of Medicine in St. Louis, Missouri, United StatesKeith M RICH - Department of Neurological Surgery, Washington University School of Medicine in St. Louis, Missouri, United StatesRalph G DACEY - Department of Neurological Surgery, Washington University School of Medicine in St. Louis, Missouri, United StatesColin P DERDEYN - Department of Neurological Surgery, Washington University School of Medicine in St. Louis, Missouri, United StatesGregory J ZIPFEL - Department of Neurological Surgery, Washington University School of Medicine in St. Louis, Missouri, United States
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery, Vol.117(3), pp.539-545
- Publisher
- American Association of Neurological Surgeons; Charlottesville, VA
- DOI
- 10.3171/2012.5.JNS111257
- PMID
- 22725983
- ISSN
- 0022-3085
- eISSN
- 1933-0693
- Language
- English
- Date published
- 2012
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984020645402771
Metrics
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