Journal article
Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas
Journal of neurointerventional surgery, Vol.15(9), pp.903-908
09/2023
DOI: 10.1136/jnis-2022-019160
PMID: 35944975
Abstract
BackgroundAnterior cranial fossa dural arteriovenous fistulas (ACF-dAVFs) are aggressive vascular lesions. The pattern of venous drainage is the most important determinant of symptoms. Due to the absence of a venous sinus in the anterior cranial fossa, most ACF-dAVFs have some degree of drainage through small cortical veins. We describe the natural history, angiographic presentation and outcomes of the largest cohort of ACF-dAVFs.MethodsThe CONDOR consortium includes data from 12 international centers. Patients included in the study were diagnosed with an arteriovenous fistula between 1990–2017. ACF-dAVFs were selected from a cohort of 1077 arteriovenous fistulas. The presentation, angioarchitecture and treatment outcomes of ACF-dAVF were extracted and analyzed.Results60 ACF-dAVFs were included in the analysis. Most ACF-dAVFs were symptomatic (38/60, 63%). The most common symptomatic presentation was intracranial hemorrhage (22/38, 57%). Most ACF-dAVFs drained through cortical veins (85%, 51/60), which in most instances drained into the superior sagittal sinus (63%, 32/51). The presence of cortical venous drainage predicted symptomatic presentation (OR 9.4, CI 1.98 to 69.1, p=0.01). Microsurgery was the most effective modality of treatment. 56% (19/34) of symptomatic patients who were treated had complete resolution of symptoms. Improvement of symptoms was not observed in untreated symptomatic ACF-dAVFs.ConclusionMost ACF-dAVFs have a symptomatic presentation. Drainage through cortical veins is a key angiographic feature of ACF-dAVFs that accounts for their malignant course. Microsurgery is the most effective treatment. Due to the high risk of bleeding, closure of ACF-dAVFs is indicated regardless of presentation.
Details
- Title: Subtitle
- Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas
- Creators
- Sebastian Sanchez - University of IowaAshrita Raghuram - University of IowaLinder Wendt - Institute for Clinical and Translational Science, The University of Iowa, 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 - Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USAEnrico Giordan - Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USAWaleed Brinjikji - Department of Radiology, Mayo Clinic, Rochester, Minnesota, USADiederik O Bulters - University Hospital Southampton NHS Foundation TrustAndrew Durnford - University Hospital Southampton NHS Foundation TrustW Christopher Fox - Department of Neurosurgery, Mayo Clinic Jacksonville Campus, 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 of Illinois Urbana-ChampaignAli Alaraj - Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USAAmanda 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 HospitalGregory J Zipfel - Department of Neurosurgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USAColin Derdeyn - Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAEdgar A Samaniego - Departments of Neurology, Radiology and Neurosurgery, The University of Iowa, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- Journal of neurointerventional surgery, Vol.15(9), pp.903-908
- DOI
- 10.1136/jnis-2022-019160
- PMID
- 35944975
- NLM abbreviation
- J Neurointerv Surg
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Publisher
- BMJ Publishing Group Ltd
- Language
- English
- Electronic publication date
- 08/09/2022
- Date published
- 09/2023
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984281634102771
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