Journal article
Dural arteriovenous fistulas without cortical venous drainage: presentation, treatment, and outcomes
Journal of neurosurgery, Vol.136(4), pp.942-950
09/10/2021
DOI: 10.3171/2021.1.JNS202825
PMID: 34507278
Abstract
Current evidence suggests that intracranial dural arteriovenous fistulas (dAVFs) without cortical venous drainage (CVD) have a benign clinical course. However, no large study has evaluated the safety and efficacy of current treatments and their impact over the natural history of dAVFs without CVD.
The authors conducted an analysis of the retrospectively collected multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database. Patient demographics and presenting symptoms, angiographic features of the dAVFs, and treatment outcomes of patients with Borden type I dAVFs were reviewed. Clinical and radiological follow-up information was assessed to determine rates of new intracranial hemorrhage (ICH) or nonhemorrhagic neurological deficit (NHND), worsening of venous hyperdynamic symptoms (VHSs), angiographic recurrence, and progression or spontaneous regression of dAVFs over time.
A total of 342 patients/Borden type I dAVFs were identified. The mean patient age was 58.1 ± 15.6 years, and 62% were women. The mean follow-up time was 37.7 ± 54.3 months. Of 230 (67.3%) treated dAVFs, 178 (77%) underwent mainly endovascular embolization, 11 (4.7%) radiosurgery alone, and 4 (1.7%) open surgery as the primary modality. After the first embolization, most dAVFs (47.2%) achieved only partial reduction in early venous filling. Multiple complementary interventions increased complete obliteration rates from 37.9% after first embolization to 46.7% after two or more embolizations, and 55.2% after combined radiosurgery and open surgery. Immediate postprocedural complications occurred in 35 dAVFs (15.2%) and 6 (2.6%) with permanent sequelae. Of 127 completely obliterated dAVFs by any therapeutic modality, 2 (1.6%) showed angiographic recurrence/recanalization at a mean of 34.2 months after treatment. Progression to Borden-Shucart type II or III was documented in 2.2% of patients and subsequent development of a new dAVF in 1.6%. Partial spontaneous regression was found in 22 (21.4%) of 103 nontreated dAVFs. Multivariate Cox regression analysis demonstrated that older age, NHND, or severe venous-hyperdynamic symptoms at presentation and infratentorial location were associated with worse prognosis. Kaplan-Meier curves showed no significant difference for stable/improved symptoms survival probability in treated versus nontreated dAVFs. However, estimated survival times showed better trends for treated dAVFs compared with nontreated dAVFs (288.1 months vs 151.1 months, log-rank p = 0.28). This difference was statistically significant for treated dAVFs with 100% occlusion (394 months, log-rank p < 0.001).
Current therapeutic modalities for management of dAVFs without CVD may provide better symptom control when complete angiographic occlusion is achieved.
Details
- Title: Subtitle
- Dural arteriovenous fistulas without cortical venous drainage: presentation, treatment, and outcomes
- Creators
- Edgar A Samaniego - University of IowaJorge A Roa - 2Neurosurgery, andMinako Hayakawa - University of IowaChing-Jen Chen - University of Virginia Health SystemJason P Sheehan - University of Virginia Health SystemLouis J Kim - University of WashingtonIsaac Josh Abecassis - University of WashingtonMichael R Levitt - University of WashingtonRidhima Guniganti - 6Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriAkash P Kansagra - 6Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriGiuseppe Lanzino - 7Department of Neurosurgery, Mayo Clinic, Rochester, MinnesotaEnrico Giordan - 7Department of Neurosurgery, Mayo Clinic, Rochester, MinnesotaWaleed Brinjikji - 7Department of Neurosurgery, Mayo Clinic, Rochester, MinnesotaDiederik Bulters - University of SouthamptonAndrew Durnford - University of SouthamptonW Christopher Fox - University of FloridaAdam J Polifka - University of FloridaBradley A Gross - University of PittsburghSepideh Amin-Hanjani - University of Illinois ChicagoAli Alaraj - University of Illinois ChicagoAmanda Kwasnicki - University of Illinois ChicagoRobert M Starke - University of MiamiSamir Sur - University of MiamiJ Marc C van Dijk - University Medical Center GroningenAdriaan R E Potgieser - University Medical Center GroningenJunichiro Satomi - 14Department of Neurosurgery, Tokushima University, Tokushima, JapanYoshiteru Tada - 14Department of Neurosurgery, Tokushima University, Tokushima, JapanAdib 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 HospitalGregory J Zipfel - 6Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MissouriColin P Derdeyn - University of IowaConsortium for Dural Arteriovenous Fistula Outcomes Research
- Contributors
- James Rossen (Contributor) - University of Iowa, Internal Medicine
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery, Vol.136(4), pp.942-950
- DOI
- 10.3171/2021.1.JNS202825
- PMID
- 34507278
- NLM abbreviation
- J Neurosurg
- ISSN
- 0022-3085
- eISSN
- 1933-0693
- Language
- English
- Date published
- 09/10/2021
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Cardiovascular Medicine; Neurosurgery; Internal Medicine
- Record Identifier
- 9984230624902771
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