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Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas.

Authors :
Sanchez, Sebastian
Raghuram, Ashrita
Wendt, Linder
Hayakawa, Minako
Ching-Jen Chen
Sheehan, Jason P.
Kim, Louis J.
Abecassis, Isaac Josh
Levitt, Michael R.
Meyer, R. Michael
Guniganti, Ridhima
Kansagra, Akash P.
Lanzino, Giuseppe
Giordan, Enrico
Brinjikji, Waleed
Bulters, Diederik O.
Durnford, Andrew
Fox, W. Christopher
Smith, Jessica
Polifka, Adam J.
Source :
Journal of NeuroInterventional Surgery; Sep2023, Vol. 15 Issue 9, p903-908, 6p
Publication Year :
2023

Abstract

Background Anterior cranial fossa dural arteriovenous fistulas (ACF-dAVFs) are aggressive vascular lesions. The pattern of venous drainage is the most important determinant of symptoms. Due to the absence of a venous sinus in the anterior cranial fossa, most ACF-dAVFs have some degree of drainage through small cortical veins. We describe the natural history, angiographic presentation and outcomes of the largest cohort of ACF-dAVFs. Methods The CONDOR consortium includes data from 12 international centers. Patients included in the study were diagnosed with an arteriovenous fistula between 1990-2017. ACF-dAVFs were selected from a cohort of 1077 arteriovenous fistulas. The presentation, angioarchitecture and treatment outcomes of ACF-dAVF were extracted and analyzed. Results 60 ACF-dAVFs were included in the analysis. Most ACF-dAVFs were symptomatic (38/60, 63%). The most common symptomatic presentation was intracranial hemorrhage (22/38, 57%). Most ACF-dAVFs drained through cortical veins (85%, 51/60), which in most instances drained into the superior sagittal sinus (63%, 32/51). The presence of cortical venous drainage predicted symptomatic presentation (OR 9.4, CI 1.98 to 69.1, p=0.01). Microsurgery was the most effective modality of treatment. 56% (19/34) of symptomatic patients who were treated had complete resolution of symptoms. Improvement of symptoms was not observed in untreated symptomatic ACF-dAVFs. Conclusion Most ACF-dAVFs have a symptomatic presentation. Drainage through cortical veins is a key angiographic feature of ACF-dAVFs that accounts for their malignant course. Microsurgery is the most effective treatment. Due to the high risk of bleeding, closure of ACF-dAVFs is indicated regardless of presentation. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
17598478
Volume :
15
Issue :
9
Database :
Complementary Index
Journal :
Journal of NeuroInterventional Surgery
Publication Type :
Academic Journal
Accession number :
172216094
Full Text :
https://doi.org/10.1136/jnis-2022-019160