Journal article
Dural Arteriovenous Fistulas With Cognitive Impairment: Angiographic Characteristics and Treatment Outcomes
Neurosurgery, Vol.94(5), pp.1035-1043
05/2024
DOI: 10.1227/neu.0000000000002802
PMCID: PMC12967309
PMID: 38095434
Abstract
Anecdotal cases of rapidly progressing dementia in patients with dural arteriovenous fistulas (dAVFs) have been reported in small series. However, large series have not characterized these dAVFs. We conducted an analysis of the largest cohort of dAVFs presenting with cognitive impairment (dAVFs-CI), aiming to provide a detailed characterization of this subset of dAVFs.
Patients with dAVFs-CI were analyzed from the CONDOR Consortium, a multicenter repository comprising 1077 dAVFs. A propensity score matching analysis was conducted to compare dAVFs-CI with Borden type II and type III dAVFs without cognitive impairment (controls). Logistic regression was used to identify angiographic characteristics specific to dAVFs-CI. Furthermore, post-treatment outcomes were analyzed.
A total of 60 patients with dAVFs-CI and 60 control dAVFs were included. Outflow obstruction leading to venous hypertension was observed in all dAVFs-CI. Sinus stenosis was significantly associated with dAVFs-CI (OR 2.85, 95% CI: 1.16-7.55, P = .027). dAVFs-CI were more likely to have a higher number of arterial feeders (OR 1.56, 95% CI 1.22-2.05, P < .001) and draining veins (OR 2.05, 95% CI 1.05-4.46, P = .004). Venous ectasia increased the risk of dAVFs-CI (OR 2.38, 95% CI 1.13-5.11, P = .024). A trend toward achieving asymptomatic status at follow-up was observed in patients with successful closure of dAVFs (OR 2.86, 95% CI 0.85-9.56, P = .09).
Venous hypertension is a key angiographic feature of dAVFs-CI. Moreover, these fistulas present at a mean age of 58 years-old, and exhibit a complex angioarchitecture characterized by an increased number of arteriovenous connections and stenosed sinuses. The presence of venous ectasia further exacerbates the impaired drainage and contributes to the development of dAVFs-CI. Notably, in certain cases, closure of the dAVF has the potential to reverse symptoms.
Details
- Title: Subtitle
- Dural Arteriovenous Fistulas With Cognitive Impairment: Angiographic Characteristics and Treatment Outcomes
- Creators
- Sebastian Sanchez - University of IowaLinder Wendt - Institute for Clinical and Translational Science, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAMinako Hayakawa - University of IowaChing-Jen Chen - The University of Texas Health Science Center at HoustonJason P Sheehan - University of Virginia Health SystemLouis J Kim - University of WashingtonIsaac Josh Abecassis - University of WashingtonMichael R Levitt - University of WashingtonR Michael Meyer - University of WashingtonRidhima Guniganti - Department of Neurosurgery, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USAAkash P Kansagra - Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USAGiuseppe Lanzino - Mayo Clinic HospitalEnrico Giordan - Mayo Clinic HospitalWaleed Brinjikji - Mayo Clinic HospitalDiederik O Bulters - University Hospital Southampton NHS Foundation TrustAndrew Durnford - University Hospital Southampton NHS Foundation TrustW Christopher Fox - Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USAJessica Smith - Department of Neurosurgery, University of Florida, Gainesville, Florida, USAAdam J Polifka - Department of Neurosurgery, University of Florida, Gainesville, Florida, USABradley Gross - University of Pittsburgh Medical CenterSepideh Amin-Hanjani - University Hospitals of ClevelandAli Alaraj - University of Illinois Urbana-ChampaignAmanda Kwasnicki - University of Illinois Urbana-ChampaignRobert M Starke - University of MiamiStephanie H Chen - University of MiamiJ Marc C van Dijk - University of GroningenAdriaan R E Potgieser - University of GroningenJunichiro Satomi - Tokushima University HospitalYoshiteru Tada - Tokushima University HospitalRyan Phelps - University of California, San FranciscoAdib Abla - University of California, San FranciscoEthan Winkler - University of California, San FranciscoRose Du - Brigham and Women's HospitalPui Man Rosalind Lai - Brigham and Women's HospitalSantiago Ortega-Gutierrez - University of IowaGregory J Zipfel - Department of Neurosurgery, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USAColin Derdeyn - University of IowaEdgar A Samaniego - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.94(5), pp.1035-1043
- DOI
- 10.1227/neu.0000000000002802
- PMID
- 38095434
- PMCID
- PMC12967309
- NLM abbreviation
- Neurosurgery
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Grant note
- UM1TR004403 / NIH Blueprint for Neuroscience Research
- Language
- English
- Electronic publication date
- 12/14/2023
- Date published
- 05/2024
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984528110202771
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