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E-114 Middle meningeal artery fistula: a systematic review and pooled cohort analysis
  1. F Terry1,
  2. C Quispe-Vicuña1,
  3. M Cabanillas-Lazo1,
  4. E Luther2,
  5. G Saal-Zapata3,
  6. K Zullo4,
  7. J Zila-Velasque1,
  8. M Padilla1,
  9. R Alkhaddash5,
  10. J Burns-Martin5,
  11. C Alva-Díaz1,
  12. D Hoit6,
  13. A Arthur6,
  14. N Goyal7,
  15. J Sequeiros5
  1. 1Red de Eficacia Clínica y Sanitaria (REDECS), Lima, Peru
  2. 2Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA
  3. 3Neurosurgery, Servicio de Neurocirugía Endovascular. Hospital Nacional Guillermo Almenara Irigoyen – EsSalud, Lima, Peru
  4. 4American University of Antigua College of Medicine, New York, NY, USA
  5. 5Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
  6. 6Neurosurgery, Semmes-Murphey Clinic/University of Tennessee Health Science Center, Memphis, TN, USA
  7. 7Neurology, Semmes-Murphey Clinic/University of Tennessee Health Science Center, Memphis, TN, USA


Introduction Dural arteriovenous fistulas (dAVF) consists of the development of acquired abnormal shunts between a main arterial feeder and draining veins. Amongst this category, middle meningeal artery (MMA) fistula rarely presents as a complication of head trauma or iatrogenic procedures such as endovascular embolization and surgery.

Objective This study aims to perform a systematic review of the clinical predictor for acquired MMA fistula postoperative course.

Methods We searched in PubMed, Embase, Scopus, Web of Science, and Google Scholar until September 1st, 2022. The risk of bias (RoB) and quality of the studies were assessed using the Joanna Briggs Institute (JBI) assessment tool for case series and case reports. Primary outcomes were overall obliteration rate and mortality, while secondary outcomes were postprocedural complications rate. A logistic multivariate regression was performed to identify predictors of overall obliteration, mortality and postoperative complications.

Results A total of 57 studies with 74 pooled patients were included in the analysis. Predominant gender, type of population and mean age were male (55.07%), adult (59.46%) and 48.59 ± 20.99 years old, respectively. Three main fistula origin events were reported: Endovascular embolization (9.46%), surgery (12.16%) and head trauma (74.32%). The mean time to fistula diagnosis was 69.87 ± 291.87 days. The most frequent defined lesion was fistula with MMA as the only feeder (96.77%), on the left side (58.11%), with a class I, III or IIII (14.86%) venous drainage classification. The JBI risk of bias assessment revealed patient’s history and site demographic information reporting as the most neglected components in case reports and case series, respectively .Reported overall obliteration rate were high (89.19%) using endovascular (95.56%), surgical (64.29%) or conservative treatment (93.33%). After running the logistic regression, only statistically clinical predictors of overall obliteration were identified: male gender (OR = 9.5 (3.01 -23.95), p < 0.001), conservative treatment (OR = 14 (1.84 - 106.46), p = 0.011), MMA as the only feeder (OR = 11 (4.4 - 27.48), p < 0.001) and class I venous drainage (OR = 10 (1.28 - 78.12), p = 0.028).

Conclusion Literature oddly reports case series and case reports of acquired MMA fistula, doing so with an inaccurate methodological process. Most frequently occurring after head untreated head trauma. However, low mortality and postoperative complications rate might rely on its delayed sand stable development. More primary studies with a larger sample size are required to identify further clinical predictors for its postoperative course.

Disclosures F. Terry: None. C. Quispe-Vicuña: None. M. Cabanillas-Lazo: None. E. Luther: None. G. Saal-Zapata: None. K. Zullo: None. J. Zila-Velasque: None. M. Padilla: None. R. Alkhaddash: None. J. Burns-Martin: None. C. Alva-Díaz: None. D. Hoit: None. A. Arthur: None. N. Goyal: None. J. Sequeiros: None.

  • Meningeal arteries
  • Fistula
  • Iatrogenic
  • Craniocerebral trauma

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