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.
- Liquid Embolic Material
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.
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