Journal article
Observation Versus Intervention for Low-Grade Intracranial Dural Arteriovenous Fistulas
Neurosurgery, Vol.88(6), pp.1111-1120
05/13/2021
DOI: 10.1093/neuros/nyab024
PMID: 33582776
Abstract
Abstract BACKGROUND Low-grade intracranial dural arteriovenous fistulas (dAVF) have a benign natural history in the majority of cases. The benefit from treatment of these lesions is controversial. OBJECTIVE To compare the outcomes of observation versus intervention for low-grade dAVFs. METHODS We retrospectively reviewed dAVF patients from institutions participating in the CONsortium for Dural arteriovenous fistula Outcomes Research (CONDOR). Patients with low-grade (Borden type I) dAVFs were included and categorized into intervention or observation cohorts. The intervention and observation cohorts were matched in a 1:1 ratio using propensity scores. Primary outcome was modified Rankin Scale (mRS) at final follow-up. Secondary outcomes were excellent (mRS 0-1) and good (mRS 0-2) outcomes, symptomatic improvement, mortality, and obliteration at final follow-up. RESULTS The intervention and observation cohorts comprised 230 and 125 patients, respectively. We found no differences in primary or secondary outcomes between the 2 unmatched cohorts at last follow-up (mean duration 36 mo), except obliteration rate was higher in the intervention cohort (78.5% vs 24.1%, P < .001). The matched intervention and observation cohorts each comprised 78 patients. We also found no differences in primary or secondary outcomes between the matched cohorts except obliteration was also more likely in the matched intervention cohort (P < .001). Procedural complication rates in the unmatched and matched intervention cohorts were 15.4% and 19.2%, respectively. CONCLUSION Intervention for low-grade intracranial dAVFs achieves superior obliteration rates compared to conservative management, but it fails to improve neurological or functional outcomes. Our findings do not support the routine treatment of low-grade dAVFs.
Details
- Title: Subtitle
- Observation Versus Intervention for Low-Grade Intracranial Dural Arteriovenous Fistulas
- Creators
- Ching-Jen Chen - Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USAThomas J Buell - Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USADale Ding - Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USARidhima Guniganti - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USAAkash P Kansagra - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USAGiuseppe Lanzino - Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USAWaleed Brinjikji - Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USALouis Kim - Department of Neurosurgery, University of Washington, Seattle, Washington, USAMichael R Levitt - Department of Neurosurgery, University of Washington, Seattle, Washington, USAIsaac Josh Abecassis - Department of Neurosurgery, University of Washington, Seattle, Washington, USADiederik Bulters - Department of Neurosurgery, University of Southampton, Southampton, United KingdomAndrew Durnford - Department of Neurosurgery, University of Southampton, Southampton, United KingdomW Christopher Fox - Department of Neurosurgery, University of Florida, Gainesville, Florida, USAAdam J Polifka - Department of Neurosurgery, University of Florida, Gainesville, Florida, USABradley A Gross - University of Pittsburgh Medical CenterMinako Hayakawa - University of Iowa, RadiologyColin P Derdeyn - University of Iowa, RadiologyEdgar A Samaniego - University of Iowa, NeurologySepideh Amin-Hanjani - Department of Neurosurgery, University of Illinois, Chicago, Illinois, USAAli Alaraj - Department of Neurosurgery, University of Illinois, Chicago, Illinois, USAAmanda Kwasnicki - Department of Neurosurgery, University of Illinois, Chicago, Illinois, USAJ Marc C van Dijk - Department of Neurosurgery, University of Groningen, Groningen, the NetherlandsAdriaan R E Potgieser - Department of Neurosurgery, University of Groningen, Groningen, the NetherlandsRobert M Starke - University of VirginiaStephanie Chen - University of Iowa, PathologyJunichiro Satomi - Department of Neurosurgery, Tokushima University, Tokushima, JapanYoshiteru Tada - Department of Neurosurgery, Tokushima University, Tokushima, JapanAdib Abla - Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USARyan R L Phelps - Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USARose Du - Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USARosalind Lai - Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USAGregory J Zipfel - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USAJason P Sheehan - Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USAJay F Piccirillo - Washington University in Saint LouisHari Raman - Washington University in Saint LouisKim Lipsey - Mayo ClinicRoanna Vine - University of VirginiaEnrico Giordan - University of VirginiaHarry J Cloft - University of VirginiaDavid F Kallmes - University of VirginiaBruce E Pollock - University of VirginiaMichael J Link - University of VirginiaMohana Patibandla Rao - University of WashingtonGabriella Paisan - University of WashingtonR Michael Meyer - Wessex Neurological CentreCory Kelly - Wessex Neurological CentreJonathan Duffill - University of FloridaAdam Ditchfield - University of FloridaJohn Millar - University of FloridaJason Macdonald - University of FloridaDimitri Laurent - University of PittsburghBrian Hoh - University of PittsburghJessica Smith - University of Iowa, SurgeryAshley Lockerman - University of PittsburghL Dade Lunsford - University of IowaBrian T Jankowitz - University of IowaSantiago Ortega Gutierrez - University of Iowa, RadiologyDavid Hasan - University of Iowa, NeurosurgeryJorge A Roa - University of Iowa, NeurologyJames Rossen - University of Iowa, Internal MedicineWaldo Guerrero - University of Illinois, ChicagoAllen McGruder - University of Illinois, ChicagoFady T Charbel - University of Groningen, University Medical Center GroningenVictor A Aletich - University of Groningen, University Medical Center GroningenLinda Rose-Finnell - University of Groningen, University Medical Center GroningenEric C Peterson - Tokushima UniversityDileep R Yavagal - Tokushima UniversitySur Samir - Tokushima UniversityYasuhisa Kanematsu - University of California, San FranciscoNobuaki Yamamoto - University of California, San FranciscoTomoya Kinouchi - University of California, San FranciscoMasaaki Korai - University of California, San FranciscoIzumi Yamaguchi - University of California, San FranciscoYuki Yamamoto - University of California, San FranciscoEthan Winkler - Brigham and Women's HospitalRyan Phelps - Brigham and Women's HospitalMichael Lawton - Brigham and Women's HospitalMartin Rutkowski - Brigham and Women's HospitalM Ali Aziz Sultan - Brigham and Women's HospitalNirav Patel - Brigham and Women's HospitalKai U Frerichs - Brigham and Women's HospitalConsortium for Dural Arteriovenous Fistula Outcomes Research
- Resource Type
- Journal article
- Publication Details
- Neurosurgery, Vol.88(6), pp.1111-1120
- DOI
- 10.1093/neuros/nyab024
- PMID
- 33582776
- NLM abbreviation
- Neurosurgery
- ISSN
- 0148-396X
- eISSN
- 1524-4040
- Language
- English
- Date published
- 05/13/2021
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Cardiovascular Medicine; Surgery; Neurosurgery; Internal Medicine
- Record Identifier
- 9984096478802771
Metrics
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