Endovascular treatment of 170 consecutive cranial dural arteriovenous fistulae: results and complications

Abstract

This study aims to evaluate a single-center experience with endovascular treatment of cranial dural arterievenous fistulae (CDAVF). The clinical and radiological records of 170 consecutive patients harboring a CDAVF and treated endovascularly in a 16-year period were reviewed. A variety of data related to demographics, features of the lesion, treatment, outcome, and follow-up were analyzed with emphasis to the results and complications. Half of the lesions had cortical venous drainage (CVD) in the initial angiographic investigation, whereas 26 % had exclusively CVD. Sixty-seven percent of our patients presented with benign symptoms and 33 % with aggressive symptoms. In 60.5 % of the patients with benign lesion (without CVD), an anatomic cure in the immediate postinterventional angiogram without complication or permanent morbidity was achieved, whereas 69 % of the patients with aggressive lesions (with CVD) had an anatomic cure in the postinterventional final angiogram with all permanent-morbidity cases belonging to this group. The average of endovascular operation sessions per patient was 1.2. In a mean follow-up period of 2.8 years, the overall complete occlusion rate was 85.5 % (78 % for the benign group and 89.5 % for the aggressive group) and clinical cure and/or improvement rate of 93 %. The operative mortality was zero, and permanent neurologic morbidity was 2.3 %. In 73 % of our cases, N-butyl cyanoacrylate (NBCA) was used as the only or main embolic material. Endovascular embolization is the treatment of choice for CDAVF. High rates of good anatomical and clinical results, associated with very low operative complication rate can be achieved with few embolization sessions. Although mastering of a permanent embolic material is important, the therapeutic strategy should be individulized and not material based.