E-031 Dural arteriovenous fistulas without cortical venous drainage: presentation, treatment and outcomes

Abstract

of Science databases. With the assistance of a librarian, we used various combinations of keywords such as Moyamoya disease, ischemic stroke, hemorrhagic stroke, antiplatelet, and the names of individual antiplatelet agents. Titles and abstracts were screened by the first two authors (MAS and MEE), with a full-text review of relevant papers. Articles were included if they examined the effect of antiplatelet therapy on ischemic or hemorrhagic stroke or survival in patients with moyamoya disease. Results Out of 132 retrieved studies, we identified five eligible studies published between 2014 and 2019 and included 26,605 patients (9499 on antiplatelet therapy, and 17106 controls) with follow up ranging from post-operative period to 6.3 years. Only one study had a prospective design and two studies were multi-center. Three of the studies included post-bypass patients, and one included only asymptomatic moyamoya disease. The antiplatelet therapy regimens varied across the studies and included ASA, clopidogrel, or cilostazol.Three studies had a control arm that did not receive any antiplatelet therapy. In these studies, the pooled risk for a composite outcome (any ischemic or hemorrhagic stroke, or death) was lower in the antiplatelet group compared to controls (9% vs 11%; relative risk 0.85, 95% CI: 0.79 to 0.92). Conclusions The use of antiplatelet therapy in patients with moyamoya disease may confer better stroke-free survival. Multicenter prospective studies with a uniform antiplatelet protocol are needed to elucidate the potential benefits of this intervention.

Observation versus intervention for Borden type I intracranial dural arteriovenous fistula: A pooled analysis of 469 patients

“…14 Likewise, in the recent Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database with a mean follow up of 38 months, analysis of Borden Type I dAVF, 0% of the 103 conservatively managed lesions progressed to a higher grade; however, 5/218 (2.3%) of the treated dAVFs upconverted to a Borden type II or III. 6 Another rationale for treatment of low-grade fistulae is possible palliative symptomatic relief. Samaniego et al of CONDOR suggested treatment may yield superior symptomatic control when angiographic obliteration is achieved 6 ; though, propensity-matched analysis of the same cohort revealed no difference in clinical outcomes between observed and treated patients when accounting for incomplete treatments.…”

“…Our institutional experience combined with 3 comparative studies from the systematic literature review yielded 495 total patients who possessed a Borden Type I intracranial dAVF. 4,6,7 From these, 469 patients had primary outcome measures that were sufficiently detailed for inclusion in the final pooled quantitative synthesis, which included 279 patients who underwent intervention, and 190 who were observed (Table 1). The most common reported presenting symptoms was pulsatile tinnitus in 65% of patients, followed by orbital or ocular symptoms in 32% of patients, and headache in 27% of cases (Table 2).…”

“…2,3 The natural history of these lesions is widely considered benign, with an annual risk of intracerebral hemorrhage (ICH) of 0%-1.5% and an eventual upconversion to a higher grade between approximately 0%-2%. [4][5][6] Notwithstanding the benign natural history of these lesions, contemporary series detailing management report an intervention and treatment rate between 57%-67%. 6,7 Management of Borden Type I dAVFs remains controversial and it is unclear if observation or intervention better facilitates superior clinical outcomes in patients harboring these lesions.…”

“…[4][5][6] Notwithstanding the benign natural history of these lesions, contemporary series detailing management report an intervention and treatment rate between 57%-67%. 6,7 Management of Borden Type I dAVFs remains controversial and it is unclear if observation or intervention better facilitates superior clinical outcomes in patients harboring these lesions. The aim of this study was to conduct a systematic literature review and meta-analysis to directly compare the outcomes between conservative observation and intervention of any kind regarding the management of low grade, Borden Type I dAVF.…”

Letter: Stereotactic Radiosurgery for Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis and International Stereotactic Radiosurgery Society Practice Guidelines

“…However, these cases can require hours of radiation exposure for the patient over potentially multiple embolization sessions, and there is a modest risk of DAVF recurrence even after initial angiographic cure. Based on analyses of the CONDOR database, obliteration of a low-grade DAVF after a single embolization session was achieved in <40% of cases, 10 and the rate of recurrent arteriovenous shunting after angiographic cure (which required a mean of >2 embolization sessions) was 7%. 11 Based on these findings, SRS may warrant consideration as a first-line treatment for unruptured DAVFs.…”