Introduction Tentorial dural arteriovenous fistula (DAVF) are rare lesions accounting for 4% of DAVFs.1 They are known to have an aggressive neurological behavior, with a high risk of intracranial hemorrhage. As a consequence, tentorial DAVFs are often treated as soon as they are diagnosed, even in the absence of hemorrhagic history.2 We report this cases series of tentorial DAVFs, most of which were treated endovascularly.
Materials and methods From a prospectively collected database, we assessed the clinical and radiological data of all patients with a tentorial DAVF (located on the tentorium or at the falcotentorial junction) managed between 1997 and 2018. The lesions were classified according to the anatomic location of the shunt (tentorium, free margin/incisura, petrotentorial junction/insertion, falcotentorial junction) and venous drainage (sinus involved and drainage pattern). Clinical outcome was assessed according to the modified Rankin Scale (mRS).
Results Among 392 patients (420 fistulas), 51 patients (17 female) with a tentorial DAVF were included in the study: 16 patients (31%) had a falcotentorial DAVF, 6 patients (11,8%) had a tentorial DAVF, 22 patients (43%) had a petrotentorial DAVF, and 7 patients (13,7%) had an incisural DAVF. This is, to our knowledge, the largest single center cohort comparing to the currently published.1
Seven patients underwent conservative management, and 44 patients (86.3%) were treated endovascularly: 38 patients had one EVT, 5 had 2 EVT, 1 had 3 EVT (51 endovascular procedures in total). Five of these patients had a complementary surgical treatment. All patients underwent postoperative angiography. A complete obliteration of the fistula was achieved in 37 patients (84%), including 35 patients treated with EVT alone (79,5%). Eight patients faced complications during EVT, leading to a severe handicap (mRS ≥3) in 5 patients (11,3%) and death in 3 patients (6.8%).
Patients were followed for a mean duration of 7,6 months. Among the treated patients, 29 patients (65,9%) had a mRS <1, 9 patients (20,4%) a mRS=2, 2 patients (4,5%) a mRS=3, and 4 patients (9%) died.
Conclusion Endovascular treatment of tentorial DAVFs (±combined with surgery) is a feasible technique with a high cure rate. However the complication rate remains non-negligible, and precise comprehension of the shunt angioarchitecture appears critical in order to improve the clinical and angiographic outcome.
Cannizzaro D, et al. Changing clinical and therapeutic trends in tentorial dural arteriovenous fistulas: A systematic review. AJNR Am J Neuroradiol 2015;36(10):1905–11.
Tomak PR, et al. Evolution of the management of tentorial dural arteriovenous malformations. Neurosurgery 2003;52(4):750–60. (discussion 760–2).
Disclosures S. Smajda: None. R. Fahed: None. G. Ciccio: None. T. Robert: None. J. Desilles: None. H. Redjem: None. S. Escalard: None. M. Mazighi: None. R. Blanc: None. M. Piotin: None.
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