Journal article
Microsurgical Treatment of Intracranial Dural Arteriovenous Fistulas: A Collaborative Investigation From the Multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research
Neurosurgery, Vol.96(5), pp.1023-1034
05/2025
DOI: 10.1227/neu.0000000000003204
Abstract
BACKGROUND AND OBJECTIVES: First-line therapy for most intracranial dural arteriovenous fistulas (dAVFs) is endovascular embolization, but some require microsurgical ligation due to limited endovascular accessibility, anticipated lower cure rates, or unacceptable risk profiles. We investigated the most common surgically treated dAVF locations and the approaches and outcomes of each. METHODS: The Consortium for Dural Arteriovenous Fistula Outcomes Research database was retrospectively reviewed. Patients who underwent dAVF microsurgical ligation were included. Patient demographics, angiographic information, surgical details, and postoperative outcomes were collected. The 5 most common surgically treated dAVF locations were analyzed about used surgical approaches and postoperative outcomes. Univariate analyses were performed with statistical significance set at a threshold of P < .05. RESULTS: In total, 248 patients in the Consortium for Dural Arteriovenous Fistula Outcomes Research database met inclusion criteria. The 5 most common surgically treated dAVF locations were tentorial, anterior cranial fossa (ACF), transverse-sigmoid sinus (TSS), convexity/superior sagittal sinus (SSS), and torcular. Most tentorial dAVFs were approached using a suboccipital, lateral supracerebellar infratentorial approach (39.3%); extended retrosigmoid approach (ERS) (25%); or posterior subtemporal approach (19.6%). All ACF dAVFs used a subfrontal approach; 5.3% also included an anterior interhemispheric approach. Most TSS dAVFs were ligated via ERS (31.3%) or subtemporal (31.3%) approaches. All convexity/SSS dAVFs used an interhemispheric approach. All torcular dAVFs used the suboccipital, lateral supracerebellar infratentorial approach, with 10.5% undergoing simultaneous ERS craniotomy. Angiographic occlusion rates after microsurgery were 85.5%, 100%, 75.8%, 79.2%, and 73.7% for tentorial, ACF, TSS, convexity/SSS, and torcular dAVFs, respectively ( P = .02); the permanent neurological complication rates were 1.8%, 2.6%, 9.1%, 0%, and 0% ( P = .31). There were no statistically significant differences in development of complications ( P = .08) or Modified Rankin Scale at the last follow-up ( P = .11) by fistula location. CONCLUSION: Although endovascular embolization is the first-line treatment for most intracranial dAVFs, surgical ligation is an important alternative. ACF and tentorial fistulas particularly demonstrate high rates of postoperative obliteration.
Details
- Title: Subtitle
- Microsurgical Treatment of Intracranial Dural Arteriovenous Fistulas: A Collaborative Investigation From the Multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research
- Creators
- Kunal P. Raygor - University of California, San FranciscoAhmed Abdelsalam - University of MiamiDaniel A. Tonetti - University of California, San FranciscoDaniel M. S. Raper - University of California, San FranciscoRidhima Guniganti - Washington University in St. LouisAndrew J. Durnford - University Hospital Southampton NHS Foundation TrustEnrico Giordan - Mayo ClinicWaleed Brinjikji - Mayo ClinicChing-Jen Chen - The University of Texas Health Science Center at HoustonIsaac Josh Abecassis - University of WashingtonMichael R. Levitt - University of WashingtonAdam J. Polifka - University of FloridaColin P. Derdeyn - University of IowaEdgar A. Samaniego - University of IowaAmanda Kwasnicki - University of Illinois Urbana-ChampaignAli Alaraj - University of Illinois Urbana-ChampaignAdriaan R. E. Potgieser - University of GroningenStephanie Chen - University of MiamiYoshiteru Tada - Tokushima University HospitalAkash P. Kansagra - Mallinckrodt (United States)Junichiro Satomi - Tokushima University HospitalTiffany Eatz - University of MiamiEric C. Peterson - University of MiamiRobert M. Starke - University of MiamiJ. Marc C. van Dijk - University of GroningenSepideh Amin-HanjaniMinako Hayakawa - University of IowaBradley A. Gross - University of PittsburghW. Christopher Fox - Mayo Clinic in FloridaLouis Kim - University of WashingtonJason Sheehan - University of VirginiaGiuseppe Lanzino - Mayo ClinicRose Du - Brigham and Women's HospitalPui Man Rosalind Lai - University at Buffalo, State University of New YorkDiederik O. Bulters - University Hospital Southampton NHS Foundation TrustGregory J. Zipfel - Washington University in St. LouisAdib A. Abla - University of MiamiConsortium for Dural Arteriovenous Fistula Outcomes Research
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.96(5), pp.1023-1034
- DOI
- 10.1227/neu.0000000000003204
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Language
- English
- Electronic publication date
- 10/08/2024
- Date published
- 05/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984722939802771
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