Journal article
Recurrence after cure in cranial dural arteriovenous fistulas: a collaborative effort by the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR)
Journal of neurosurgery, Vol.136(4), pp.981-989
09/10/2021
DOI: 10.3171/2021.1.JNS202033
PMID: 34507283
Abstract
Cranial dural arteriovenous fistulas (dAVFs) are often treated with endovascular therapy, but occasionally a multimodality approach including surgery and/or radiosurgery is utilized. Recurrence after an initial angiographic cure has been reported, with estimated rates ranging from 2% to 14.3%, but few risk factors have been identified. The objective of this study was to identify risk factors associated with recurrence of dAVF after putative cure.
The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) data were retrospectively reviewed. All patients with angiographic cure after treatment and subsequent angiographic follow-up were included. The primary outcome was recurrence, with risk factor analysis. Secondary outcomes included clinical outcomes, morbidity, and mortality associated with recurrence. Risk factor analysis was performed comparing the group of patients who experienced recurrence with those with durable cure (regardless of multiple recurrences). Time-to-event analysis was performed using all collective recurrence events (multiple per patients in some cases).
Of the 1077 patients included in the primary CONDOR data set, 457 met inclusion criteria. A total of 32 patients (7%) experienced 34 events of recurrence at a mean of 368.7 days (median 192 days). The recurrence rate was 4.5% overall. Kaplan-Meier analysis predicted long-term recurrence rates approaching 11% at 3 years. Grade III dAVFs treated with endovascular therapy were statistically significantly more likely to experience recurrence than those treated surgically (13.3% vs 0%, p = 0.0001). Tentorial location, cortical venous drainage, and deep cerebral venous drainage were all risk factors for recurrence. Endovascular intervention and radiosurgery were associated with recurrence. Six recurrences were symptomatic, including 2 with hemorrhage, 3 with nonhemorrhagic neurological deficit, and 1 with progressive flow-related symptoms (decreased vision).
Recurrence of dAVFs after putative cure can occur after endovascular treatment. Risk factors include tentorial location, cortical venous drainage, and deep cerebral drainage. Multimodality therapy can be used to achieve cure after recurrence. A delayed long-term angiographic evaluation (at least 1 year from cure) may be warranted, especially in cases with risk factors for recurrence.
Details
- Title: Subtitle
- Recurrence after cure in cranial dural arteriovenous fistulas: a collaborative effort by the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR)
- Creators
- Isaac Josh Abecassis - Departments of1Neurological SurgeryR Michael Meyer - Departments of1Neurological SurgeryMichael R Levitt - University of WashingtonJason P Sheehan - University of Virginia Health SystemChing-Jen Chen - University of Virginia Health SystemBradley A Gross - University of PittsburghJessica Smith - University of FloridaW Christopher Fox - University of FloridaEnrico Giordan - Departments of8Neurosurgery andGiuseppe Lanzino - 9Radiology, Mayo Clinic, Rochester, MinnesotaRobert M Starke - University of MiamiSamir Sur - University of MiamiAdriaan R E Potgieser - University Medical Center GroningenJ Marc C van Dijk - University Medical Center GroningenAndrew Durnford - University of SouthamptonDiederik Bulters - University of SouthamptonJunichiro Satomi - 13Department of Neurosurgery, Tokushima University, Tokushima, JapanYoshiteru Tada - 13Department of Neurosurgery, Tokushima University, Tokushima, JapanAmanda Kwasnicki - University of Illinois ChicagoSepideh Amin-Hanjani - University of Illinois ChicagoAli Alaraj - University of Illinois ChicagoEdgar A Samaniego - University of IowaMinako Hayakawa - University of IowaColin P Derdeyn - University of IowaEthan Winkler - University of California, San FranciscoAdib Abla - University of California, San FranciscoPui Man Rosalind Lai - Brigham and Women's HospitalRose Du - Brigham and Women's HospitalRidhima Guniganti - Departments of18Neurological SurgeryAkash P Kansagra - 20Neurology, Washington University School of Medicine, St. Louis, MissouriGregory J Zipfel - Departments of18Neurological SurgeryLouis J Kim - University of WashingtonConsortium for Dural Arteriovenous Fistula Outcomes Research
- Resource Type
- Journal article
- Publication Details
- Journal of neurosurgery, Vol.136(4), pp.981-989
- DOI
- 10.3171/2021.1.JNS202033
- PMID
- 34507283
- NLM abbreviation
- J Neurosurg
- eISSN
- 1933-0693
- Language
- English
- Date published
- 09/10/2021
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984230624102771
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