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  • Clinical Outcomes After Endovascular Treatment of 102 Dural Arteriovenous Fistulas Without Cortical Venous Reflux

    Final Number:
    117

    Authors:
    Bradley A Gross MD; Felipe Albuquerque MD; Karam Moon MD; Cameron G. McDougall MD

    Study Design:
    Clinical trial

    Subject Category:
    Vascular Malformations

    Meeting: AANS/CNS Cerebrovascular Section 2016 Annual Meeting

    Introduction: Although dural arteriovenous fistulas (dAVF)s without cortical venous reflux (CVR) do not pose a risk of venous hypertension/hemorrhage, they can cause debilitating pulsatile tinnitus, ocular symptoms or develop CVR. Clinical outcomes reported across large patient cohorts with these dAVFs are sparse.

    Methods: We reviewed our endovascular database from 1995-October 2015 for cranial dAVFs without CVR treated initially endovascularly. We extracted demographic, angiographic, treatment and follow-up data.

    Results: Our analysis included 100 patients with 102 distinct dAVFs. Patients presented with either pulsatile tinnitus (61%) and/or ocular symptoms (42%). dAVF location was transverse/sigmoid in 42% of cases, cavernous in 40%, marginal sinus in 10%, torcular in 5%, superior sagittal sinus in 2% and petrosal in 1%. The initial angiographic occlusion rate improved from 63% to 75% following the introduction of Onyx (p = 0.28). The complication rate was 5% with 1% of patients having permanent neurological sequelae. Among patients with dAVFs with pulsatile tinnitus, resolution after treatment was seen in 59% of cases, tolerable improvement in 20% and persistence in 21% over a mean follow-up period of 3 years. Angiographically-occluded fistulas were associated with a greater rate of symptomatic resolution/improvement of tinnitus as compared to partially treated lesions (90% vs 62%, p = 0.04). Among patients with ocular symptoms, resolution after treatment was seen in 48% of cases, tolerable improvement in 30% and persistence/worsening in 22% over a mean follow-up period of 2 years. Angiographically-occluded dAVFs were associated with greater rates of symptomatic resolution/improvement of ocular symptoms than partially treated dAVFs (85% vs 33%, p = 0.02).

    Conclusions: Endovascular treatment of dAVFs without CVR is associated with a high rate of symptomatic improvement/resolution with low procedural morbidity.

    Patient Care: Encourages endovascular treatment of low risk fistulas and provides clinically useful rates of symptomatic improvement/resolution for patient counseling.

    Learning Objectives: 1) Low risk dAVF endovascular treatment is associated with an approximately 80% rate of symptomatic improvement/resolution after initial treatment. 2) Onyx has improved angiographic obliteration 3) Angiographic obliteration is significantly associated with higher rates of symptomatic improvement

    References:

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