Microsurgical Treatment of Intracranial Dural Arteriovenous Fistulas: A Collaborative Investigation From the Multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research

Kunal P Raygor¹, Ahmed Abdelsalam², Daniel A Tonetti¹, Daniel M S Raper¹, Ridhima Guniganti³, Andrew J Durnford⁴, Enrico Giordan⁵, Waleed Brinjikji⁶, Ching-Jen Chen⁷, Isaac Josh Abecassis⁸, Michael R Levitt⁸, Adam J Polifka⁹, Colin P Derdeyn¹⁰, Edgar A Samaniego^{10

11

12}, Amanda Kwasnicki¹³, Ali Alaraj¹³, Adriaan R E Potgieser¹⁴, Stephanie Chen², Yoshiteru Tada¹⁵, Akash P Kansagra¹⁶, Junichiro Satomi¹⁵, Tiffany Eatz², Eric C Peterson², Robert M Starke², J Marc C van Dijk¹⁴, Sepideh Amin-Hanjani^{13

17}, Minako Hayakawa^{10

12}, Bradley A Gross¹⁸, W Christopher Fox¹⁹, Louis Kim⁸, Jason Sheehan²⁰, Giuseppe Lanzino⁵, Rose Du²¹, Pui Man Rosalind Lai²², Diederik O Bulters⁴, Gregory J Zipfel³, Adib A Abla²; Consortium for Dural Arteriovenous Fistula Outcomes Research

Affiliations

¹ Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
² Department of Neurological Surgery, University of Miami, Coral Gables, Florida, USA.
³ Department of Neurological Surgery, Washington University of St. Louis, St. Louis, Missouri, USA.
⁴ Department of Neurosurgery, University Hospital Southampton, Southampton, UK.
⁵ Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
⁷ Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁸ Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
⁹ Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA.
¹⁰ Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹¹ Department of Neurological Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹² Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹³ Department of Neurological Surgery, University of Illinois Chicago, Chicago, Illinois, USA.
¹⁴ Department of Neurological Surgery, University of Groningen, Groningen, the Netherlands.
¹⁵ Department of Neurological Surgery, Tokushima University Hospital, Tokushima, Japan.
¹⁶ Mallinckrodt Institute of Radiology, Washington University of St. Louis, St. Louis, Missouri, USA.
¹⁷ Department of Neurosurgery, University Hospitals/Case Western Reserve University, Cleveland, Ohio, USA.
¹⁸ Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁹ Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.
²⁰ Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
²¹ Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
²² Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA.

PMID: 39471093
DOI: 10.1227/neu.0000000000003204

Microsurgical Treatment of Intracranial Dural Arteriovenous Fistulas: A Collaborative Investigation From the Multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research

Kunal P Raygor et al. Neurosurgery. 2024.

. 2024 Oct 8.

doi: 10.1227/neu.0000000000003204. Online ahead of print.

Authors

Affiliations

¹ Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
² Department of Neurological Surgery, University of Miami, Coral Gables, Florida, USA.
³ Department of Neurological Surgery, Washington University of St. Louis, St. Louis, Missouri, USA.
⁴ Department of Neurosurgery, University Hospital Southampton, Southampton, UK.
⁵ Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA.
⁶ Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
⁷ Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas, USA.
⁸ Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
⁹ Department of Neurological Surgery, University of Florida, Gainesville, Florida, USA.
¹⁰ Department of Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹¹ Department of Neurological Surgery, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹² Department of Neurology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
¹³ Department of Neurological Surgery, University of Illinois Chicago, Chicago, Illinois, USA.
¹⁴ Department of Neurological Surgery, University of Groningen, Groningen, the Netherlands.
¹⁵ Department of Neurological Surgery, Tokushima University Hospital, Tokushima, Japan.
¹⁶ Mallinckrodt Institute of Radiology, Washington University of St. Louis, St. Louis, Missouri, USA.
¹⁷ Department of Neurosurgery, University Hospitals/Case Western Reserve University, Cleveland, Ohio, USA.
¹⁸ Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁹ Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA.
²⁰ Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
²¹ Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
²² Department of Neurosurgery, University at Buffalo, Buffalo, New York, USA.

PMID: 39471093
DOI: 10.1227/neu.0000000000003204

Abstract

Background and objectives: First-line therapy for most intracranial dural arteriovenous fistulas (dAVFs) is endovascular embolization, but some require microsurgical ligation due to limited endovascular accessibility, anticipated lower cure rates, or unacceptable risk profiles. We investigated the most common surgically treated dAVF locations and the approaches and outcomes of each.

Methods: The Consortium for Dural Arteriovenous Fistula Outcomes Research database was retrospectively reviewed. Patients who underwent dAVF microsurgical ligation were included. Patient demographics, angiographic information, surgical details, and postoperative outcomes were collected. The 5 most common surgically treated dAVF locations were analyzed about used surgical approaches and postoperative outcomes. Univariate analyses were performed with statistical significance set at a threshold of P < .05.

Results: In total, 248 patients in the Consortium for Dural Arteriovenous Fistula Outcomes Research database met inclusion criteria. The 5 most common surgically treated dAVF locations were tentorial, anterior cranial fossa (ACF), transverse-sigmoid sinus (TSS), convexity/superior sagittal sinus (SSS), and torcular. Most tentorial dAVFs were approached using a suboccipital, lateral supracerebellar infratentorial approach (39.3%); extended retrosigmoid approach (ERS) (25%); or posterior subtemporal approach (19.6%). All ACF dAVFs used a subfrontal approach; 5.3% also included an anterior interhemispheric approach. Most TSS dAVFs were ligated via ERS (31.3%) or subtemporal (31.3%) approaches. All convexity/SSS dAVFs used an interhemispheric approach. All torcular dAVFs used the suboccipital, lateral supracerebellar infratentorial approach, with 10.5% undergoing simultaneous ERS craniotomy. Angiographic occlusion rates after microsurgery were 85.5%, 100%, 75.8%, 79.2%, and 73.7% for tentorial, ACF, TSS, convexity/SSS, and torcular dAVFs, respectively (P = .02); the permanent neurological complication rates were 1.8%, 2.6%, 9.1%, 0%, and 0% (P = .31). There were no statistically significant differences in development of complications (P = .08) or Modified Rankin Scale at the last follow-up (P = .11) by fistula location.

Conclusion: Although endovascular embolization is the first-line treatment for most intracranial dAVFs, surgical ligation is an important alternative. ACF and tentorial fistulas particularly demonstrate high rates of postoperative obliteration.

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References

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1. Guedon A, Saint-Maurice JP, Thepenier C, et al. Results of transvenous embolization of intracranial dural arteriovenous fistula: a consecutive series of 136 patients with 142 fistulas. J Neurosurg. 2021;135(6):1636-1644.
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Microsurgical Treatment of Intracranial Dural Arteriovenous Fistulas: A Collaborative Investigation From the Multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research

Affiliations

Microsurgical Treatment of Intracranial Dural Arteriovenous Fistulas: A Collaborative Investigation From the Multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research

Authors

Affiliations

Abstract

References

LinkOut - more resources

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