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E-031 Dural arteriovenous fistulas without cortical venous drainage: presentation, treatment and outcomes
  1. E Samaniego1,
  2. J Roa2,
  3. M Hayakawa3,
  4. S Ortega-Gutierrez1,
  5. R Guniganti4,
  6. D Bulters5,
  7. A Alaraj6,
  8. S Amin-Hanjani6,
  9. G Lanzino7,
  10. G Zipfel4,
  11. D Hasan8,
  12. C Derdeyn3
  1. 1Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
  2. 2Neurology and Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA
  3. 3Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA
  4. 4Neurosurgery, Washington University School of Medicine, St. Louis, MO
  5. 5Neurosurgery, University Hospital Southampton, Southampton, UK
  6. 6Neurosurgery, University of Illinois Hospital, Chicago, IL
  7. 7Neurosurgery, Mayo Clinic, Rochester, MN
  8. 8Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA


Background Current evidence suggests that intracranial dural arteriovenous fistulas (dAVFs) lacking cortical venous drainage (CVD) have a benign clinical course. However, there is no large study evaluating the safety/efficacy of current treatments and their impact over the natural history of no-CVD dAVFs.

Methods We conducted an analysis of the retrospectively collected multi-center Consortium for dAVF Outcomes Research (CONDOR) database. Demographics, presenting symptoms, dAVFs’ angiographic features and therapeutic intervention/complications data of patients with Borden-Shucart type 1 dAVFs were reviewed. Clinical and radiological follow-up information was assessed to determine rates of new intracranial hemorrhage or non-hemorrhagic neurological deficit (NHND), worsening of venous hyperdynamic symptoms (VHS), angiographic recurrence, progression or spontaneous regression of dAVFs over time.

Results A total of 368 patients/Borden-Shucart type I dAVFs were identified. For patients with multiple dAVFs, only the largest one was included in the analysis. Mean age was 57.9±15.6 years, and 60.9% were women. Mean follow-up time was 40.1±45.2 months. The most common location was the transverse/sigmoid sinus (50.3%). Of 240 treated dAVFs, 224 (93.3%) underwent endovascular embolization, 11 (4.9%) radiosurgery alone and 5 (2.1%) open surgery as primary modality. After first embolization, most dAVFs (45.5%) achieved only partial reduction in early venous filling. Multiple complementary interventions increased complete obliteration rates from 37.5% after first embolization to 45.5% after 2 or more embolizations, and 53.8% after complimentary radiosurgery/open surgery. Immediate post-procedural complications occurred in 38 treated dAVFs (15.8%) and 7 with permanent sequelae. Of 129 completely obliterated dAVFs by any therapeutic modality, 3 (2.3%) showed angiographic recurrence/recanalization in a mean time of 10 months after treatment. Progression to Borden-Shucart types II-III was documented in 2.4% and subsequent development of new dAVF in 1.5%. Partial spontaneous regression was found in 24 out of 115 non-treated dAVFs with follow-up available (20.9%). Multivariate Cox regression analysis demonstrated that NHND or severe VHS at presentation and infratentorial location were associated with worse prognosis. Kaplan-Meier curves demonstrated no significant difference for stable/improved symptoms survival probability in treated versus non-treated dAVFs. However, estimated survival times showed better trends for treated dAVFs compared with non-treated dAVFs (179.2 months vs 163 months, Log-rank p-value = 0.12). This difference was statistically significant for treated dAVFs with 100% occlusion compared with partially-occluded dAVFs (173.2 months vs 143.9 months, Log-rank p-value < 0.001).

Abstract E-031 Figure 1 Subgroup Kaplan-Meier survival analysis for treated type I dAVFs that achieved complete angiographic obliteration

Conclusion Current therapeutic modalities for management of dAVFs without CVD are safe and may provide better symptom control when complete angiographic occlusion can be achieved.

Disclosures E. Samaniego: 1; C; SVIN 2019, Bee Foundation 2019. 2; C; Medtronic, MicroVention. J. Roa: None. M. Hayakawa: None. S. Ortega-Gutierrez: 2; C; Stryker, Medtronic. R. Guniganti: None. D. Bulters: None. A. Alaraj: None. S. Amin-Hanjani: None. G. Lanzino: None. G. Zipfel: None. D. Hasan: None. C. Derdeyn: None.

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