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

Sebastian Sanchez¹, Ashrita Raghuram¹, Linder Wendt², Minako Hayakawa³, Ching-Jen Chen⁴, Jason P Sheehan⁵, Louis J Kim⁶, Isaac Josh Abecassis⁶, Michael R Levitt⁶, R Michael Meyer⁶, Ridhima Guniganti⁷, Akash P Kansagra⁸, Giuseppe Lanzino⁹, Enrico Giordan⁹, Waleed Brinjikji¹⁰, Diederik O Bulters¹¹, Andrew Durnford¹¹, W Christopher Fox¹², Jessica Smith¹³, Adam J Polifka¹³, Bradley Gross¹⁴, Sepideh Amin-Hanjani¹⁵, Ali Alaraj¹⁵, Amanda Kwasnicki¹⁵, Robert M Starke¹⁶, Stephanie H Chen¹⁶, J Marc C van Dijk¹⁷, Adriaan R E Potgieser¹⁷, Junichiro Satomi¹⁸, Yoshiteru Tada¹⁸, Ryan Phelps¹⁹, Adib Abla¹⁹, Ethan Winkler¹⁹, Rose Du²⁰, Pui Man Rosalind Lai²⁰, Gregory J Zipfel⁷, Colin Derdeyn³, Edgar A Samaniego²¹

Affiliations

¹ Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
² Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, USA.
³ Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
⁴ Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁵ Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
⁶ Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
⁷ Department of Neurosurgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA.
⁸ Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA.
⁹ Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
¹⁰ Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK.
¹² Department of Neurosurgery, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA.
¹³ Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
¹⁴ Department of Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
¹⁵ Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA.
¹⁶ Department of Neurosurgery, University of Miami, Coral Gables, Florida, USA.
¹⁷ Department of Neurosurgery, University of Groningen, Groningen, Groningen, Netherlands.
¹⁸ Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan.
¹⁹ Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.
²⁰ Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
²¹ Departments of Neurology, Radiology and Neurosurgery, The University of Iowa, Iowa City, Iowa, USA edgarsama@gmail.com.

PMID: 35944975
DOI: 10.1136/jnis-2022-019160

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

Sebastian Sanchez et al. J Neurointerv Surg. 2023 Sep.

. 2023 Sep;15(9):903-908.

doi: 10.1136/jnis-2022-019160. Epub 2022 Aug 9.

Authors

Affiliations

¹ Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
² Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, USA.
³ Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
⁴ Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁵ Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
⁶ Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
⁷ Department of Neurosurgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA.
⁸ Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA.
⁹ Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
¹⁰ Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
¹¹ Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK.
¹² Department of Neurosurgery, Mayo Clinic Jacksonville Campus, Jacksonville, Florida, USA.
¹³ Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
¹⁴ Department of Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
¹⁵ Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA.
¹⁶ Department of Neurosurgery, University of Miami, Coral Gables, Florida, USA.
¹⁷ Department of Neurosurgery, University of Groningen, Groningen, Groningen, Netherlands.
¹⁸ Department of Neurosurgery, Tokushima University Hospital, Tokushima, Tokushima, Japan.
¹⁹ Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.
²⁰ Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
²¹ Departments of Neurology, Radiology and Neurosurgery, The University of Iowa, Iowa City, Iowa, USA edgarsama@gmail.com.

PMID: 35944975
DOI: 10.1136/jnis-2022-019160

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.

Keywords: Fistula; Hemorrhage; Intervention.

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Conflict of interest statement

Competing interests: LJK is a co-founder of Spi Surgical and reports compensation for consultant services from Microvention. IJA reports stock options in Remedy Robotics and compensation from Remedy Robotics and InNeuroCo for consultant services. MRL reports equity interest in Propio, Cerebrotech and Synchron, and grants from Stryker, Volcano Philips and Medtronic. MRL is part of the editorial board of JNIS. APK reports compensation from Penumbra and Microvention for consultant services. WB reports compensation for consultant services from Johnson & Johnson, Stryker, Medtronic Vascular and Microvention; compensation from MIVI Neurovascular for data and safety monitoring services; stock holdings from Marblehead Medical LLC. AJP reports compensation from DePuy Synthes Spine for consultant services. BG reports compensation from Microvention and Medtronic for consultant services. AA reports compensation from Johnson & Johnson and Cerenovous for consultant services. RMS reports consulting and teaching agreements with Penumbra, Abbott, Medtronic, InNeuroCo and Cerenovous. RD reports compensation from Grand Rounds for consultant services and compensation from NIH for other services. CD reports stock options from Euphrates Vascular; compensation from noNO and Penumbra, Inc for data and safety monitoring services. EAS is a proctor with Microvention and reports compensation from Medtronic and Rapid Medical for consultant services.

Comment in

Correspondence on "Natural history, angiographic presentation and outcome of anterior cranial fossa dural arteriovenous fistulas" by Sanchez et al.
Su X, Gao Z, Ma Y, Song Z, Zhang H, Zhang P, Ye M. Su X, et al. J Neurointerv Surg. 2023 Sep;15(9):932. doi: 10.1136/jnis-2023-020401. Epub 2023 May 17. J Neurointerv Surg. 2023. PMID: 37197933 No abstract available.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

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