Cranial Dural Arteriovenous Fistulas: Decision-making, Results, and Complications in a Contemporary Consecutive Series of 60 Patients.David John Daniels, MD1, Michael Link, MD1, Harry Cloft, MD, PhD1, David Kallmes, MD1, Giuseppe Lanzino, MD11Rochester, MN United States Keywords: dural arteriovenous fistula, complications, arteriovenous fistula, outcome, hemorrhage
Development and further refinements of endovascular techniques and stereotactic radiosurgery have changed the treatment paradigm of intracranial dural arteriovenous fistulas (DAVFs).
We describe decision-making, results and complications in a prospective contemporary series.
Sixty consecutive patients evaluated for DAVFs at our institution since 2008 were included in a prospective database.
Data collected include patient demographics, presenting symptoms and signs, angioarchitecture, treatment recommendations, clinical outcomes, complications, and radiological follow-up.
Thirty-five patients underwent endovascular embolization as the primary treatment: transvenous embolization (TVE) was used in 15 patients with complete obliteration in 93% of cases; Onyx embolization was used in 17 patients with complete obliteration in 82%; and transarterial particle embolization (TAE) was used alone in 3 patients without success. Six patients underwent surgical excision after failed embolization with 83% completely obliterated. Fourteen patients were treated with Gamma Knife radiosurgery. Observation was recommended in 12 patients. Complete resolution or significant improvement of symptoms was seen in: 85% of patients treated with TVE; 87% of Onyx cases, 33% treated with TAE alone; 75% of surgical cases; and 80% of Gamma Knife patients. There was no mortality and no permanent neurological sequelae. One patient suffered a transient seventh nerve palsy after TAE, while another patient suffered an access complication (groin hematoma). No adverse radiation complications were identified in Gamma Knife patients.
This is a retrospective study.
A treatment strategy utilizing different treatment modalities and techniques alone or in combination based on clinical and angiographic features is highly effective and safe in the modern management of intracranial DAVFs.
D. Daniels (), M. Link (), H. Cloft (), D. Kallmes (), G. Lanzino ()