Current Status of Endovascular Treatment for Dural Arteriovenous Fistulas in the Superior Sagittal Sinus Region: A Systematic Review of the Literature

Abstract

Background: Dural arteriovenous fistulas (DAVFs) occurring in the superior sagittal sinus (SSS) region are difficult to cure. Endovascular treatment (EVT) is an effective method for the treatment of SSS region DAVFs. Currently, no systematic review of EVT for SSS region DAVFs is available. A systematic review of the literature is necessary.

Methods: A systematic PubMed search for studies related to SSS region DAVFs published after 1990 in English was performed on October 15, 2018.

Results: Thirty-three studies involving 42 patients, including 31 (73.8%, 31/42) men, were finally identified. Of the 42 patients, 12 (28.6%, 12/42) patients mainly presented with intracranial hemorrhage, and 9 (21.4%, 9/42) patients presented with cognitive impairment. Of the 42 patients, 31 (73.8%, 31/42) patients were treated via transarterial embolization, and 11 (26.2%, 11/42) patients were treated via transvenous embolization. Of the 42 patients, 41 (97.6%, 41/42) patients had a clear angiographic outcome, and complete angiographic cure was achieved in 36 (87.8%, 36/41) patients. Of the 42 patients, 4 (9.5%, 4/42) patients were reported to have procedural complications. Of the 42 patients, 37 (88.1%, 37/42) patients had a definite description of the follow-up outcome, 22 (59.5%, 22/37) patients had a modified Ranking Scale score of 0, and 12 (32.4%, 12/37) patients had an improved neurologic state.

Conclusions: In treating SSS region DAVFs, EVT can completely obliterate the fistula point and correct venous shunting. Thus, currently EVT is an effective treatment for SSS region DAVFs. Although many complications can occur, this approach achieves good outcomes in most cases.

Keywords: Dural arteriovenous fistula; Endovascular treatment; Review; Superior sagittal sinus.