Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes.

An increasing number of intracranial dural arteriovenous fistulas (DAVFs) are amenable to endovascular treatment with Onyx-18. We reviewed our experience with the endovascular management of tentorial dural arteriovenous fistulas (TDAVFs) treated transarterially and transvenously. Clinical records for 19 consecutive patients (three women, 16 men) with TDAVFs treated endovascularly between 2005 and 2008 were reviewed to determine their presenting symptoms, angiographic features, endovascular treatments, and clinical outcomes. Most patients (78.9%) presented with intracranial hemorrhage (ICH). All patients had high-risk angiographic features such as leptomeningeal venous varix. Transarterial embolization was performed in 19 patients. Transvenous embolization was additionally performed in two patients and caused one death. At the time of the last follow-up evaluation, 16 (84.2%) patients had good or excellent outcomes (modified Rankin score, 0 or 1) and one (5.3%) was deceased. Six patients had a residual fistula and were treated with gamma knife radiosurgery. The overall morbidity and mortality rate was 10.5%. High-risk TDAVFs can be successfully managed with good outcomes. When anatomic features can be accessed endovascularly, endovascular treatment is indicated. Patients with residual filling of the DAVF should be considered for adjuvant therapy, including further radiosurgery. [ABSTRACT FROM AUTHOR]