Endovascular treatment of dural arteriovenous fistulas involving the vein of Galen: a single-center cohort and meta-analysis.

Autor:	Lauzier DC; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA dlauzier@wustl.edu., Ullman H; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA., Hardi A; Bernard Becker Medical Library, Washington University School of Medicine, St Louis, Missouri, USA., Derdeyn C; Department of Radiology, University of Iowa Medical Center, Iowa City, Iowa, USA., Cross DT; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA., Moran CJ; Mallinckrodt Institute of Radiology and Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2024 Nov 22; Vol. 16 (12), pp. 1320-1326. Date of Electronic Publication: 2024 Nov 22.
DOI:	10.1136/jnis-2023-020843
Abstrakt:	Background: Dural arteriovenous fistulas (dAVFs) draining into the vein of Galen (VoG) are complex lesions that often necessitate treatment to minimize the risk of rupture and relieve symptoms. These lesions can be treated with open surgical resection, radiosurgery, or endovascular embolization. Unfortunately, endovascular treatment of dAVFs involving the VoG has not been robustly assessed across large patient cohorts. To meet this need, we performed a retrospective review of dAVFs involving the VoG at our center, and included these in a meta-analysis to identify the safety and efficacy of endovascular embolization, as well as describing current treatment trends for this disease. Methods: Consecutive patients with dAVFs involving the VoG treated at a single center were identified from a prospective database and retrospectively reviewed. A literature search was conducted with defined search criteria, and eligible studies were included alongside our cohort in a meta-analysis. Rates of complete dAVF treatment and clinical complications were pooled across studies with a random effects model and reported with a 95% CI. Results: Five dAVFs involving the VoG were treated endovascularly at our center during the study period. In this series, 80% of treatments led to complete occlusion of the fistula while no patients had clinical complications. Onyx was used for all treatments. In our meta-analysis, the overall rate of complete occlusion was 72.0% (95% CI 59.8% to 84.1%) and the overall rate of clinical complications was 10.0% (95% CI 4.7% to 15.3%). Conclusions: Endovascular approaches for dAVFs involving the VoG are technically feasible, but carry a risk of clinical complications. Future work should identify optimal endovascular embolic agents. Competing Interests: Competing interests: CJM is a consultant for Medtronic, Cerenovus, Microvention, Stryker, and Balt. CD is a consultant (DSMBs) for Penumbra (MIND, THUNDER trials), NoNO (ESCAPE-Na1), and Silk Road (NITE trial). (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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