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Endovascular treatment of dural arteriovenous fistulas involving the vein of Galen: a single-center cohort and meta-analysis
  1. David C Lauzier1,
  2. Henrik Ullman1,
  3. Angela Hardi2,
  4. Colin Derdeyn3,
  5. Dewitte T Cross1,
  6. Christopher J Moran4
  1. 1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
  2. 2Bernard Becker Medical Library, Washington University School of Medicine, St Louis, Missouri, USA
  3. 3Department of Radiology, University of Iowa Medical Center, Iowa City, Iowa, USA
  4. 4Mallinckrodt Institute of Radiology and Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA
  1. Correspondence to David C Lauzier, Washington University in St Louis School of Medicine, St Louis, USA; dlauzier{at}


Background Dural arteriovenous fistulas (dAVFs) draining into the vein of Galen (VoG) are complex lesions that often necessitate treatment to minimize the risk of rupture and relieve symptoms. These lesions can be treated with open surgical resection, radiosurgery, or endovascular embolization. Unfortunately, endovascular treatment of dAVFs involving the VoG has not been robustly assessed across large patient cohorts. To meet this need, we performed a retrospective review of dAVFs involving the VoG at our center, and included these in a meta-analysis to identify the safety and efficacy of endovascular embolization, as well as describing current treatment trends for this disease.

Methods Consecutive patients with dAVFs involving the VoG treated at a single center were identified from a prospective database and retrospectively reviewed. A literature search was conducted with defined search criteria, and eligible studies were included alongside our cohort in a meta-analysis. Rates of complete dAVF treatment and clinical complications were pooled across studies with a random effects model and reported with a 95% CI.

Results Five dAVFs involving the VoG were treated endovascularly at our center during the study period. In this series, 80% of treatments led to complete occlusion of the fistula while no patients had clinical complications. Onyx was used for all treatments. In our meta-analysis, the overall rate of complete occlusion was 72.0% (95% CI 59.8% to 84.1%) and the overall rate of clinical complications was 10.0% (95% CI 4.7% to 15.3%).

Conclusions Endovascular approaches for dAVFs involving the VoG are technically feasible, but carry a risk of clinical complications. Future work should identify optimal endovascular embolic agents.

  • Coil
  • Fistula
  • Liquid Embolic Material

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors Study conception: DCL and CJM. Data collection: DCL, HU, AH. Data analysis: DCL and AH. Manuscript writing: DCL and CJM. Critical revision: CD, DTC, CJM. Final approval: DCL, HU, AH, CD, DTC, CJM. All authors read and approved the submitted manuscript. DCL serves as the guarantor and accepts full responsibility for the work and conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CJM is a consultant for Medtronic, Cerenovus, Microvention, Stryker, and Balt. CD is a consultant (DSMBs) for Penumbra (MIND, THUNDER trials), NoNO (ESCAPE-Na1), and Silk Road (NITE trial).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.