RT Journal Article
SR Electronic
T1 Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 903
OP 908
DO 10.1136/jnis-2022-019160
VO 15
IS 9
A1 Sanchez, Sebastian
A1 Raghuram, Ashrita
A1 Wendt, Linder
A1 Hayakawa, Minako
A1 Chen, Ching-Jen
A1 Sheehan, Jason P
A1 Kim, Louis J
A1 Abecassis, Isaac Josh
A1 Levitt, Michael R
A1 Meyer, R Michael
A1 Guniganti, Ridhima
A1 Kansagra, Akash P
A1 Lanzino, Giuseppe
A1 Giordan, Enrico
A1 Brinjikji, Waleed
A1 Bulters, Diederik O
A1 Durnford, Andrew
A1 Fox, W Christopher
A1 Smith, Jessica
A1 Polifka, Adam J
A1 Gross, Bradley
A1 Amin-Hanjani, Sepideh
A1 Alaraj, Ali
A1 Kwasnicki, Amanda
A1 Starke, Robert M
A1 Chen, Stephanie H
A1 van Dijk, J Marc C
A1 Potgieser, Adriaan R E
A1 Satomi, Junichiro
A1 Tada, Yoshiteru
A1 Phelps, Ryan
A1 Abla, Adib
A1 Winkler, Ethan
A1 Du, Rose
A1 Lai, Pui Man Rosalind
A1 Zipfel, Gregory J
A1 Derdeyn, Colin
A1 Samaniego, Edgar A
YR 2023
UL http://jnis.bmj.com/content/15/9/903.abstract
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.