Angio-architecture of complex cranial dural arteriovenous fistulas: A single centre retrospective review of treatment modalities and outcomes

Object Management of dural arteriovenous fistulas (DAVFs) has changed during the last decades due to increased knowledge of their pathophysiology and natural history as well as advances in treatment modalities. The authors describe the characteristics and long-term outcome of a large consecutive series of patients with DAVFs. Methods Altogether 251 patients with 261 DAVFs were treated in 2 of the 5 neurosurgery departments at Helsinki and Kuopio University Hospitals between 1944 and 2006. Clinical data and radiological examinations were reviewed to assess patients' overall long-term clinical outcome. Results The detection rate of DAVFs increased markedly in the 1970s and again in the 1990s when digital subtraction angiography was introduced. The incidence of DAVFs in a defined southern Finnish population was 0.51 per 100,000 individuals per year, which represents 32% of all the brain arteriovenous malformations. In the early part of the series, DAVFs were treated by proximal ligation of the feeding arteries. Later, most of the patients underwent preoperative embolization and subsequent craniotomy, and since 2000 stereotactic radiosurgery has been increasingly used in the treatment of DAVFs. Fifty-nine percent of the 261 fistulas were totally occluded. Treatment-related major complications were seen in 21 patients. Conclusions The advances in diagnostic methods (digital subtraction angiography, CT, and MRI) increased the detection rate of DAVFs, and as treatment modalities developed, the results of treatment and outcome of patients markedly improved with the introduction of endovascular techniques and stereotactic radiosurgery. Microsurgery is of limited use in DAVFs resistant to other treatment modalities.

Download Full-text

Modified Borden Grading System For Cranial And Spinal Dural Arteriovenous Fistulas In Neuroendovsacular Era

10.21203/rs.3.rs-810322/v1 ◽

2021 ◽

Author(s):

Xianli Lv ◽

Ke Zhu ◽

Jiangdian Wang

Keyword(s):

Treatment Modalities ◽

Grading System ◽

Type Ii ◽

Type Iii ◽

Arteriovenous Fistulas ◽

Grading Systems ◽

Dural Arteriovenous Fistulas ◽

Pre Treatment ◽

Spinal Dural Arteriovenous Fistulas ◽

Effective Assessment

Abstract Objective:Dural arteriovenous fistulas (DAVFs) is a complex condition in neurovascular surgery. Many DAVF classifications have been reported and have changed over time in the literatures. The purposes of this study was to propose a practical and easy-to-follow grading system for DAVFs.Methods: From a retrospective analysis of our database, 143 DAVF patients were consecutively collected. Patients were grouped into modified Borden types I, II and III. Patients’ characteristics, treatment and outcomes were analyzed between 3 types. Patients’ pre-treatment status(pre-mRS) were analyzed between Borden, Cognard and modified Borden grading systems. Results:Male and non-sinus locations were statistically significantly correlated with the type III DAVF type (p<0.001). More than 3 pedical suppliers and pial arterial suppliers were associated with high grade (type II and III) DAVFs(p=0.003). Worse symptoms were present in most type II and type III patients(p<0.001). Type III DAVF was associated with TAE and type II DAVF was associated with TVE treatment modalities(p<0.001). The results of one-way ANOVA indicated that pre-mRS was significantly different within modified Borden types and Cognard types (p = 4.3×10-6 and p = 1×10-4, respectively). In terms of pre-mRS, patients were not separated well using Cognard grading systems.Conclusions: A modified grading system of cerebral and spinal DAVFs was promoted according to understanding of angioarchitectures in order to evaluate risk of DAVFs and guide the therapies of these lesions. The modified Borden grading system was informative by providing an effective assessment for the risk of patients with simple but precise results.

Download Full-text

Are type I dural arteriovenous fistulas safe? Single-centre experience of endovascular treatment of dural arteriovenous fistulas

Polish Journal of Radiology ◽

10.5114/pjr.2019.84602 ◽

2019 ◽

Vol 84 ◽

pp. 179-184

Author(s):

Krzysztof Brzozowski ◽

Jerzy Narloch ◽

Piotr Piasecki ◽

Piotr Zięcina ◽

Andrzej Koziarski

Keyword(s):

Endovascular Treatment ◽

Type I ◽

Single Centre ◽

Arteriovenous Fistulas ◽

Single Centre Experience ◽

Dural Arteriovenous Fistulas

Download Full-text

Recurrence Rates After Surgical or Endovascular Treatment of Spinal Dural Arteriovenous Fistulas

Neurosurgery ◽

10.1227/neu.0000000000000727 ◽

2015 ◽

Vol 77 (1) ◽

pp. 137-144 ◽

Cited By ~ 35

Author(s):

Nicolaas A. Bakker ◽

Maarten Uyttenboogaart ◽

G.J. Luijckx ◽

Omid S. Eshghi ◽

Aryan Mazuri ◽

...

Keyword(s):

Surgical Treatment ◽

Endovascular Treatment ◽

Meta Analysis ◽

Treatment Modalities ◽

Endovascular Techniques ◽

Recurrence Rates ◽

Arteriovenous Fistulas ◽

Initial Failure ◽

Dural Arteriovenous Fistulas ◽

Spinal Dural Arteriovenous Fistulas

Abstract BACKGROUND: There is an increasing tendency to treat spinal dural arteriovenous fistulas (SDAVFs) endovascularly despite the lack of clear evidence favoring embolization over surgery. OBJECTIVE: To compare the initial failure and recurrence rates of primary treatment of SDAVFs by surgery and endovascular techniques. METHODS: A meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standard was performed. All the English literature from 2004 onward was evaluated. From each article that compared the 2 treatment modalities, the odds ratio (OR) was calculated. Combined ORs were calculated with Review Manager 5.3 of The Cochrane Collaboration. RESULTS: A total of 35 studies harboring 1112 patients were assessed. Initial definitive fistula occlusion was observed in 588 of 609 surgical patients (96.6%; 95% confidence interval [CI], 94.8–97.8) vs 363 of 503 endovascularly treated patients (72.2%; 95% CI, 68.1–75.9; P < .001). The combined OR from 18 studies that assessed both treatment modalities (730 patients) was 6.15 (95% CI, 3.45–11.0) in favor of surgical treatment. Late recurrence (13 studies, 480 patients) revealed an OR of 3.15 (95% CI, 1.66–5.96; P < .001) in favor of surgery. In a subgroup, recurrence was reported in 10 of 22 patients (45%) treated with Onyx vs 8 of 35 (23%) treated with n-butyle-2-cyanoacrylate (OR, 2.51; 95% CI, 0.75–8.37; P = .13). CONCLUSION: Although hampered by inclusion of poor quality studies, this meta-analysis shows a definite advantage of primary surgical treatment of SDAVF over endovascular treatment in initial failure rate and late recurrences. The often-used argument that endovascular techniques have improved and therefore outweigh surgery is not supported by this meta-analysis.

Download Full-text