Dural arteriovenous fistulas are not observed to convert to a higher grade after partial embolization

Erin Walker, University of South Carolina School of Medicine, Greenville, South Carolina.
Anja Srienc, Department of Neurological Surgery, Washington University in St. Louis, Missouri.
Daphne Lew, Center for Biostatistics and Data Science, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
Ridhima Guniganti, Department of Neurological Surgery, Washington University in St. Louis, Missouri.
Giuseppe Lanzino, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
Waleed Brinjikji, Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota.
Minako Hayakawa, Department of Radiology and Interventional Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Edgar A. Samaniego, Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Colin P. Derdeyn, Department of Radiology and Interventional Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Rose Du, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts.
Rosalind Lai, Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts.
Jason P. Sheehan, Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
Robert M. Starke, Neurosurgery Department, University of Miami Miller School of Medicine, Miami, Florida.
Adib Abla, Neurosurgery Department, University of Miami Miller School of Medicine, Miami, Florida.
Ahmed Abdelsalam, Neurosurgery Department, University of Miami Miller School of Medicine, Miami, Florida.
Bradley Gross, Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Felipe Albuquerque, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
Louis J. Kim, Department of Neurosurgery, University of Washington, Seattle, Washington.
Michael Levitt, Department of Neurosurgery, University of Washington, Seattle, Washington.
Sepideh Amin-Hanjani, Neurosurgery Department, University Hospitals/Case Western Reserve University, Cleveland, Ohio.
Ali Alaraj, Department of Neurosurgery, University of Illinois College of Medicine at Chicago, Illinois.
Ethan Winkler, Department of Neurosurgery, University of California, San Francisco, California.
W Christopher Fox, Department of Neurosurgery, University of Florida, Gainesville, Florida.
Adam Polifka, Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida.
Samuel Hall, Wessex Neurological Centre, Southampton General Hospital, Southampton, United Kingdom.
Diederik Bulters, Wessex Neurological Centre, Southampton General Hospital, Southampton, United Kingdom.
Andrew Durnford, Wessex Neurological Centre, Southampton General Hospital, Southampton, United Kingdom.
Junichiro Satomi, Department of Neurosurgery, University of Tokushima, Japan.
Yoshiteru Tada, Department of Neurosurgery, University of Tokushima, Japan.
J Marc van Dijk, Department of Neurosurgery, University of Groningen, The Netherlands; and.

Document Type

Article

Abstract

OBJECTIVE: Borden-Shucart type I dural arteriovenous fistulas (dAVFs) lack cortical venous drainage and occasionally necessitate intervention depending on patient symptoms. Conversion is the rare transformation of a low-grade dAVF to a higher grade. Factors associated with increased risk of dAVF conversion to a higher grade are poorly understood. The authors hypothesized that partial treatment of type I dAVFs is an independent risk factor for conversion. METHODS: The multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research database was used to perform a retrospective analysis of all patients with type I dAVFs. RESULTS: Three hundred fifty-eight (33.2%) of 1077 patients had type I dAVFs. Of those 358 patients, 206 received endovascular treatment and 131 were not treated. Two (2.2%) of 91 patients receiving partial endovascular treatment for a low-grade dAVF experienced conversion to a higher grade, 2 (1.5%) of 131 who were not treated experienced conversion, and none (0%) of 115 patients who received complete endovascular treatment experienced dAVF conversion. The majority of converted dAVFs localized to the transverse-sigmoid sinus and all received embolization as part of their treatment. CONCLUSIONS: Partial treatment of type I dAVFs does not appear to be significantly associated with conversion to a higher grade.

Medical Subject Headings

Humans; Retrospective Studies; Central Nervous System Vascular Malformations (diagnostic imaging, surgery); Embolization, Therapeutic (adverse effects); Endovascular Procedures (adverse effects); Risk Factors; Treatment Outcome

Publication Date

3-1-2024

Publication Title

Neurosurgical focus

E-ISSN

1092-0684

Volume

56

Issue

3

First Page

E8

PubMed ID

38428013

Digital Object Identifier (DOI)

10.3171/2024.1.FOCUS23745

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