PT  - JOURNAL ARTICLE
AU  - Sanchez, Sebastian
AU  - Raghuram, Ashrita
AU  - Wendt, Linder
AU  - Hayakawa, Minako
AU  - Chen, Ching-Jen
AU  - Sheehan, Jason P
AU  - Kim, Louis J
AU  - Abecassis, Isaac Josh
AU  - Levitt, Michael R
AU  - Meyer, R Michael
AU  - Guniganti, Ridhima
AU  - Kansagra, Akash P
AU  - Lanzino, Giuseppe
AU  - Giordan, Enrico
AU  - Brinjikji, Waleed
AU  - Bulters, Diederik O
AU  - Durnford, Andrew
AU  - Fox, W Christopher
AU  - Smith, Jessica
AU  - Polifka, Adam J
AU  - Gross, Bradley
AU  - Amin-Hanjani, Sepideh
AU  - Alaraj, Ali
AU  - Kwasnicki, Amanda
AU  - Starke, Robert M
AU  - Chen, Stephanie H
AU  - van Dijk, J Marc C
AU  - Potgieser, Adriaan R E
AU  - Satomi, Junichiro
AU  - Tada, Yoshiteru
AU  - Phelps, Ryan
AU  - Abla, Adib
AU  - Winkler, Ethan
AU  - Du, Rose
AU  - Lai, Pui Man Rosalind
AU  - Zipfel, Gregory J
AU  - Derdeyn, Colin
AU  - Samaniego, Edgar A
TI  - Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas
AID  - 10.1136/jnis-2022-019160
DP  - 2023 Sep 01
TA  - Journal of NeuroInterventional Surgery
PG  - 903--908
VI  - 15
IP  - 9
4099  - http://jnis.bmj.com/content/15/9/903.short
4100  - http://jnis.bmj.com/content/15/9/903.full
SO  - J NeuroIntervent Surg2023 Sep 01; 15
AB  - 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.Data are available upon reasonable request.