Endovascular treatment strategy and clinical outcome of tentorial dural arteriovenous fistula

Abstract

Introduction: To evaluate treatment strategies and clinical outcomes following endovascular embolization of tentorial dural arteriovenous fistulas.

Methods: We retrospectively analyzed 19 patients with tentorial dural arteriovenous fistulas admitted to the Department of Neurosurgery at Jiangsu Provincial People's Hospital between October 2015 and May 2022, all treated with endovascular therapy. To collect and analyze patients' clinical presentation, imaging data, postoperative complications, and prognosis and to analyze the safety and clinical outcomes of endovascular treatment of tentorial dural arteriovenous fistulas.

Results: Imaging cure was achieved in 18 patients, with the arterial route chosen for embolization in 17 patients and the venous route in one patient; one patient received partial embolization. Staged embolization was performed in four patients. At postoperative follow-up of 9-83 months (37.8 ± 21.2), all 19 patients had recovered well (mRS score ≤ 2). Three patients experienced perioperative complications: intraoperative Onyx reflux into the middle cerebral artery in one patient; postoperative permanent limited left visual field loss and deafness in the left ear in one patient; and transient diplopia, vertigo, and decreased pain and temperature sensation of the left limb in one patient, with no abnormalities on post-procedure magnetic resonance examinations. A total of 17 patients completed a postoperative digital subtraction angiography review during follow-up, and one patient had a recurrence of an arteriovenous fistula.

Conclusion: Endovascular treatment of tentorial dural arteriovenous fistulas is safe and effective. Reduction of the Borden or Cognard classification via eliminating cortical venous reflux through multi-staged embolization or combined open surgery is a reasonable goal of treatment where complete obliteration of the fistula is not achievable.

Keywords: arteriovenous fistulas; endovascular treatment; outcome; strategy; tentorial.

Figure 1

Adult patient presented with headache for 1 month, whose DSA suggested a tentorial dural arteriovenous fistula of type G3. (A,B) are the frontal and lateral views of the right external carotid artery, showing the right occipital, middle meningeal, and ascending pharyngeal arteries involved in the blood supply. (C,D) are the frontal and lateral views of the left external carotid artery showing the left occipital, middle meningeal, and posterior auricular arteries involved in the blood supply. (E) We chose the bilateral middle meningeal artery route for the embolization of TDAVF. (F,G) are postoperative bilateral external carotid arteriograms showing complete embolization of the TDAVF. (H) is a postoperative cranial CT showing hyperdense embolic shadow in the sinus convergence area. Red arrows point to arteries, and green arrows point to TDAVF.

Figure 2

Adult patient presented with headache for 1 week, whose DSA suggested a tentorial dural arteriovenous fistula of type G6. (A,B) are the frontal and lateral views of the left external carotid artery, showing the left occipital, posterior auricular, middle meningeal, and ascending pharyngeal arteries involved in the blood supply. (C) We chose the left occipital artery route for embolization of TDAVF. (D) is a postoperative left external carotid arteriogram showing complete embolization of the TDAVF. (E) is a postoperative cranial CT showing hyperdense embolic shadow. In (F), there was no recurrence of TDAVF on 3-month postoperative angiography. Red arrows point to arteries, and green arrows point to TDAVF.