Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

Sebastian Sanchez, Ashrita Raghuram, Linder Wendt, Minako Hayakawa, Ching Jen Chen, Jason P. Sheehan, Louis J. Kim, Isaac Josh Abecassis, Michael R. Levitt, R. Michael Meyer, Ridhima Guniganti, Akash P. Kansagra, Giuseppe Lanzino, Enrico Giordan, Waleed Brinjikji, Diederik O. Bulters, Andrew Durnford, W. Christopher Fox, Jessica Smith, Adam J. PolifkaBradley Gross, Sepideh Amin-Hanjani, Ali Alaraj, Amanda Kwasnicki, Robert M. Starke, Stephanie H. Chen, J. Marc C. Van Dijk, Adriaan R.E. Potgieser, Junichiro Satomi, Yoshiteru Tada, Ryan Phelps, Adib Abla, Ethan Winkler, Rose Du, Pui Man Rosalind Lai, Gregory J. Zipfel, Colin Derdeyn, Edgar A. Samaniego

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Anterior cranial fossa dural arteriovenous fistulas (ACF-dAVFs) are aggressive vascular lesions. The pattern of venous drainage is the most important determinant of symptoms. Due to the absence of a venous sinus in the anterior cranial fossa, most ACF-dAVFs have some degree of drainage through small cortical veins. We describe the natural history, angiographic presentation and outcomes of the largest cohort of ACF-dAVFs. Methods: The CONDOR consortium includes data from 12 international centers. Patients included in the study were diagnosed with an arteriovenous fistula between 1990-2017. ACF-dAVFs were selected from a cohort of 1077 arteriovenous fistulas. The presentation, angioarchitecture and treatment outcomes of ACF-dAVF were extracted and analyzed. Results: 60 ACF-dAVFs were included in the analysis. Most ACF-dAVFs were symptomatic (38/60, 63%). The most common symptomatic presentation was intracranial hemorrhage (22/38, 57%). Most ACF-dAVFs drained through cortical veins (85%, 51/60), which in most instances drained into the superior sagittal sinus (63%, 32/51). The presence of cortical venous drainage predicted symptomatic presentation (OR 9.4, CI 1.98 to 69.1, p=0.01). Microsurgery was the most effective modality of treatment. 56% (19/34) of symptomatic patients who were treated had complete resolution of symptoms. Improvement of symptoms was not observed in untreated symptomatic ACF-dAVFs. Conclusion: Most ACF-dAVFs have a symptomatic presentation. Drainage through cortical veins is a key angiographic feature of ACF-dAVFs that accounts for their malignant course. Microsurgery is the most effective treatment. Due to the high risk of bleeding, closure of ACF-dAVFs is indicated regardless of presentation.

Original languageEnglish (US)
Article numberneurintsurg-2022-019160
JournalJournal of neurointerventional surgery
DOIs
StateAccepted/In press - 2022

Keywords

  • Fistula
  • Hemorrhage
  • Intervention

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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