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. 2023 Dec 14.
doi: 10.1227/neu.0000000000002802. Online ahead of print.

Dural Arteriovenous Fistulas With Cognitive Impairment: Angiographic Characteristics and Treatment Outcomes

Sebastian Sanchez  1 , Linder Wendt  2 , Minako Hayakawa  3 , Ching-Jen Chen  4 , Jason P Sheehan  5 , Louis J Kim  6 , Isaac Josh Abecassis  6 , Michael R Levitt  6 , R Michael Meyer  6 , Ridhima Guniganti  7 , Akash P Kansagra  8 , Giuseppe Lanzino  9 , Enrico Giordan  9 , Waleed Brinjikji  10 , Diederik O Bulters  11 , Andrew Durnford  11 , W Christopher Fox  12 , Jessica Smith  13 , Adam J Polifka  13 , Bradley Gross  14 , Sepideh Amin-Hanjani  15   16 , Ali Alaraj  15 , Amanda Kwasnicki  15 , Robert M Starke  17 , Stephanie H Chen  17 , J Marc C van Dijk  18 , Adriaan R E Potgieser  18 , Junichiro Satomi  19 , Yoshiteru Tada  19 , Ryan Phelps  20 , Adib Abla  20 , Ethan Winkler  20 , Rose Du  21 , Pui Man Rosalind Lai  21 , Santiago Ortega-Gutierrez  1   3   22 , Gregory J Zipfel  7 , Colin Derdeyn  2 , Edgar A Samaniego  1   3   22
Affiliations

Dural Arteriovenous Fistulas With Cognitive Impairment: Angiographic Characteristics and Treatment Outcomes

Sebastian Sanchez et al. Neurosurgery. .

Abstract

Background and objectives: Anecdotal cases of rapidly progressing dementia in patients with dural arteriovenous fistulas (dAVFs) have been reported in small series. However, large series have not characterized these dAVFs. We conducted an analysis of the largest cohort of dAVFs presenting with cognitive impairment (dAVFs-CI), aiming to provide a detailed characterization of this subset of dAVFs.

Methods: Patients with dAVFs-CI were analyzed from the CONDOR Consortium, a multicenter repository comprising 1077 dAVFs. A propensity score matching analysis was conducted to compare dAVFs-CI with Borden type II and type III dAVFs without cognitive impairment (controls). Logistic regression was used to identify angiographic characteristics specific to dAVFs-CI. Furthermore, post-treatment outcomes were analyzed.

Results: A total of 60 patients with dAVFs-CI and 60 control dAVFs were included. Outflow obstruction leading to venous hypertension was observed in all dAVFs-CI. Sinus stenosis was significantly associated with dAVFs-CI (OR 2.85, 95% CI: 1.16-7.55, P = .027). dAVFs-CI were more likely to have a higher number of arterial feeders (OR 1.56, 95% CI 1.22-2.05, P < .001) and draining veins (OR 2.05, 95% CI 1.05-4.46, P = .004). Venous ectasia increased the risk of dAVFs-CI (OR 2.38, 95% CI 1.13-5.11, P = .024). A trend toward achieving asymptomatic status at follow-up was observed in patients with successful closure of dAVFs (OR 2.86, 95% CI 0.85-9.56, P = .09).

Conclusion: Venous hypertension is a key angiographic feature of dAVFs-CI. Moreover, these fistulas present at a mean age of 58 years-old, and exhibit a complex angioarchitecture characterized by an increased number of arteriovenous connections and stenosed sinuses. The presence of venous ectasia further exacerbates the impaired drainage and contributes to the development of dAVFs-CI. Notably, in certain cases, closure of the dAVF has the potential to reverse symptoms.

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References

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