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Comparative Study
. 2021 May 13;88(6):1111-1120.
doi: 10.1093/neuros/nyab024.

Observation Versus Intervention for Low-Grade Intracranial Dural Arteriovenous Fistulas

Ching-Jen Chen  1 , Thomas J Buell  1 , Dale Ding  2 , Ridhima Guniganti  3 , Akash P Kansagra  3   4   5 , Giuseppe Lanzino  6 , Waleed Brinjikji  6 , Louis Kim  7 , Michael R Levitt  7 , Isaac Josh Abecassis  7 , Diederik Bulters  8 , Andrew Durnford  8 , W Christopher Fox  9 , Adam J Polifka  9 , Bradley A Gross  10 , Minako Hayakawa  11 , Colin P Derdeyn  11 , Edgar A Samaniego  11 , Sepideh Amin-Hanjani  12 , Ali Alaraj  12 , Amanda Kwasnicki  12 , J Marc C van Dijk  13 , Adriaan R E Potgieser  13 , Robert M Starke  14   15 , Stephanie Chen  14 , Junichiro Satomi  16 , Yoshiteru Tada  16 , Adib Abla  17 , Ryan R L Phelps  17 , Rose Du  18 , Rosalind Lai  18 , Gregory J Zipfel  3 , Jason P Sheehan  1 ; Consortium for Dural Arteriovenous Fistula Outcomes Research
Collaborators, Affiliations
Comparative Study

Observation Versus Intervention for Low-Grade Intracranial Dural Arteriovenous Fistulas

Ching-Jen Chen et al. Neurosurgery. .

Abstract

Background: Low-grade intracranial dural arteriovenous fistulas (dAVF) have a benign natural history in the majority of cases. The benefit from treatment of these lesions is controversial.

Objective: To compare the outcomes of observation versus intervention for low-grade dAVFs.

Methods: We retrospectively reviewed dAVF patients from institutions participating in the CONsortium for Dural arteriovenous fistula Outcomes Research (CONDOR). Patients with low-grade (Borden type I) dAVFs were included and categorized into intervention or observation cohorts. The intervention and observation cohorts were matched in a 1:1 ratio using propensity scores. Primary outcome was modified Rankin Scale (mRS) at final follow-up. Secondary outcomes were excellent (mRS 0-1) and good (mRS 0-2) outcomes, symptomatic improvement, mortality, and obliteration at final follow-up.

Results: The intervention and observation cohorts comprised 230 and 125 patients, respectively. We found no differences in primary or secondary outcomes between the 2 unmatched cohorts at last follow-up (mean duration 36 mo), except obliteration rate was higher in the intervention cohort (78.5% vs 24.1%, P < .001). The matched intervention and observation cohorts each comprised 78 patients. We also found no differences in primary or secondary outcomes between the matched cohorts except obliteration was also more likely in the matched intervention cohort (P < .001). Procedural complication rates in the unmatched and matched intervention cohorts were 15.4% and 19.2%, respectively.

Conclusion: Intervention for low-grade intracranial dAVFs achieves superior obliteration rates compared to conservative management, but it fails to improve neurological or functional outcomes. Our findings do not support the routine treatment of low-grade dAVFs.

Keywords: Cortical venous reflux; Dural arteriovenous fistula; Embolization; Endovascular; Intracranial; Radiosurgery; Surgery.

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