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Dural arteriovenous fistulas without cortical venous drainage: presentation, treatment, and outcomes.

Publication ,  Journal Article
Samaniego, EA; Roa, JA; Hayakawa, M; Chen, C-J; Sheehan, JP; Kim, LJ; Abecassis, IJ; Levitt, MR; Guniganti, R; Kansagra, AP; Lanzino, G; Du, R ...
Published in: J Neurosurg
April 1, 2022

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: Current therapeutic modalities for management of dAVFs without CVD may provide better symptom control when complete angiographic occlusion is achieved.

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Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

April 1, 2022

Volume

136

Issue

4

Start / End Page

942 / 950

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Humans
  • Female
  • Embolization, Therapeutic
  • Drainage
  • Central Nervous System Vascular Malformations
  • Aged
 

Citation

APA
Chicago
ICMJE
MLA
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Samaniego, E. A., Roa, J. A., Hayakawa, M., Chen, C.-J., Sheehan, J. P., Kim, L. J., … CONDOR Collaborators, . (2022). Dural arteriovenous fistulas without cortical venous drainage: presentation, treatment, and outcomes. J Neurosurg, 136(4), 942–950. https://doi.org/10.3171/2021.1.JNS202825
Samaniego, Edgar A., Jorge A. Roa, Minako Hayakawa, Ching-Jen Chen, Jason P. Sheehan, Louis J. Kim, Isaac Josh Abecassis, et al. “Dural arteriovenous fistulas without cortical venous drainage: presentation, treatment, and outcomes.J Neurosurg 136, no. 4 (April 1, 2022): 942–50. https://doi.org/10.3171/2021.1.JNS202825.
Samaniego EA, Roa JA, Hayakawa M, Chen C-J, Sheehan JP, Kim LJ, et al. Dural arteriovenous fistulas without cortical venous drainage: presentation, treatment, and outcomes. J Neurosurg. 2022 Apr 1;136(4):942–50.
Samaniego, Edgar A., et al. “Dural arteriovenous fistulas without cortical venous drainage: presentation, treatment, and outcomes.J Neurosurg, vol. 136, no. 4, Apr. 2022, pp. 942–50. Pubmed, doi:10.3171/2021.1.JNS202825.
Samaniego EA, Roa JA, Hayakawa M, Chen C-J, Sheehan JP, Kim LJ, Abecassis IJ, Levitt MR, Guniganti R, Kansagra AP, Lanzino G, Giordan E, Brinjikji W, Bulters D, Durnford A, Fox WC, Polifka AJ, Gross BA, Amin-Hanjani S, Alaraj A, Kwasnicki A, Starke RM, Sur S, van Dijk JMC, Potgieser ARE, Satomi J, Tada Y, Abla A, Winkler E, Du R, Lai PMR, Zipfel GJ, Derdeyn CP, Consortium for Dural Arteriovenous Fistula Outcomes Research, CONDOR Collaborators. Dural arteriovenous fistulas without cortical venous drainage: presentation, treatment, and outcomes. J Neurosurg. 2022 Apr 1;136(4):942–950.

Published In

J Neurosurg

DOI

EISSN

1933-0693

Publication Date

April 1, 2022

Volume

136

Issue

4

Start / End Page

942 / 950

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Humans
  • Female
  • Embolization, Therapeutic
  • Drainage
  • Central Nervous System Vascular Malformations
  • Aged