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

Autor: Edgar A. Samaniego, Jorge A. Roa, Minako Hayakawa, Ching-Jen Chen, Jason P. Sheehan, Louis J. Kim, Isaac Josh Abecassis, Michael R. Levitt, Ridhima Guniganti, Akash P. Kansagra, Giuseppe Lanzino, Enrico Giordan, Waleed Brinjikji, Diederik Bulters, Andrew Durnford, W. Christopher Fox, Adam J. Polifka, Bradley A. Gross, Sepideh Amin-Hanjani, Ali Alaraj, Amanda Kwasnicki, Robert M. Starke, Samir Sur, J. Marc C. van Dijk, Adriaan R. E. Potgieser, Junichiro Satomi, Yoshiteru Tada, Adib Abla, Ethan Winkler, Rose Du, Pui Man Rosalind Lai, Gregory J. Zipfel, Colin P. Derdeyn, Jay F. Piccirillo, Hari Raman, Kim Lipsey, Roanna Vine, Harry J. Cloft, David F. Kallmes, Bruce E. Pollock, Michael J. Link, Jason Sheehan, Mohana Rao Patibandla, Dale Ding, Thomas Buell, Gabriella Paisan, R. Michael Meyer, Cory Kelly, Jonathan Duffill, Adam Ditchfield, John Millar, Jason Macdonald, Dimitri Laurent, Brian Hoh, Jessica Smith, Ashley Lockerman, L. Dade Lunsford, Brian T. Jankowitz, Santiago Ortega Gutierrez, David Hasan, James Rossen, Waldo Guerrero, Allen McGruder, Fady T. Charbel, Victor A. Aletich, Linda Rose-Finnell, Eric C. Peterson, Dileep R. Yavagal, Stephanie H. Chen, Yasuhisa Kanematsu, Nobuaki Yamamoto, Tomoya Kinouchi, Masaaki Korai, Izumi Yamaguchi, Yuki Yamamoto, Ryan R. L. Phelps, Michael Lawton, Martin Rutkowski, M. Ali Aziz-Sultan, Nirav Patel, Kai U. Frerichs
Přispěvatelé: Movement Disorder (MD)
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Journal of Neurosurgery, 136(4). AMER ASSOC NEUROLOGICAL SURGEONS
ISSN: 0022-3085
Popis: 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.
Databáze: OpenAIRE
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