Epidemiology of Dural Arteriovenous Fistula in Japan: Analysis of Japanese Registry of Neuroendovascular Therapy (JR-NET2)

Abstract

We developed the Japanese Registry of Neuroendovascular Therapy 2 (JR-NET2) database and used the information for a retrospective, nation-wide multicenter, observational study to clarify the clinical characteristics, current status of procedures, and outcome of patients treated by neuroendovascular therapy in Japan. In this report, we analyzed the clinical characteristics of dural arteriovenous fistulas (dAVFs) in the JR-NET2 database. All patients with dAVFs treated with endovascular therapy in 150 Japanese hospitals were included. Patient characteristics, clinical presentations, and imaging characteristics were analyzed. A total of 1,075 patients with dAVFs underwent 1,520 endovascular procedures. Of 1,075 patients, 45% were men and 55% were women. The mean age was 65 ± 13 years. The most frequent location of dAVFs was the cavernous sinus (43.6%), followed by the transverse-sigmoid sinus (TSS) (33.4%). Twelve percent of the patients had intracranial hemorrhage, 9% had venous infarction, and 3% had convulsion. The statistically significant independent risk factors of intracranial hemorrhage were TSS, superior sagittal sinus (SSS), tentorium, anterior cranial fossa, cranio-cervical junction, cortical venous reflux (CVR), and varix. Risk factors of venous infarction were age older than 60 years, male sex, TSS, SSS, and CVR. Risk factors of convulsion were male sex, SSS, and CVR. This is the largest nationwide report, to date, of the clinical characteristics of dAVFs treated by neuroendovascular therapy. CVR was a major risk factor of aggressive symptoms.

Evaluation of Intracranial Dural Arteriovenous Fistulas: Comparison of Unenhanced 3T 3D Time-of-flight MR Angiography with Digital Subtraction Angiography

“…5 Risk factors for intracranial hemorrhage include shunt location (e.g., transverse-sigmoid sinus, superior sagittal sinus, tentorium, anterior cranial fossa, and craniocervical junction), cortical venous drainage, and varix. 6 On the other hand, the disease course of a cranial DAVF without cortical venous drainage is benign. Observation or palliative treatment has resulted in a benign and tolerable level of disease in 98.5% of cases.…”

A Case of Postoperative Transverse Sinus Dural Arteriovenous Fistula Treated with Selective Sinus Packing: Usefulness of Quadriaxial Catheter System

“…In addition, if areas around the shunt are occluded, transvenous access routes are closed, and treatment becomes difficult. 1,[5][6][7] In this event, the first-line treatment is transvenous recanalization of the occluded area using a hard guidewire, but this is often difficult. 2) If this procedure is impossible, alternatives including direct sinus packing by a small craniotomy, occlusion of the outflow tract by craniotomy, and transarterial embolization must be considered, 23) but the first two approaches are deemed to be inferior to TVE in invasiveness and the last approach in radicalness.…”

“…1,2) It has also been reported to have occurred after craniotomy. 3,4) Also, dural AVF arising in the transverse-sigmoid sinus becomes complicated by outflow tract obstruction as it advances, and symptoms are rapidly exacerbated to present aggressive features, requiring urgent treatment.…”

“…3,4) Also, dural AVF arising in the transverse-sigmoid sinus becomes complicated by outflow tract obstruction as it advances, and symptoms are rapidly exacerbated to present aggressive features, requiring urgent treatment. 1,[5][6][7] However, in this stage, treatment is often difficult because of obstruction of the transvenous access route. 2) Here, we report a case in which a quadriaxial catheter system was useful for recanalization of the occluded transvenous access route, which led to selective coil embolization.…”

A Shunt of the Diploic Vein of the Orbital Roof Accompanying a Cavernous Sinus Dural Arteriovenous Fistula: A Case Report

“…1) Embolization of the whole sinus has been recommended. 2) However, a large amount of coils and longer procedure time are required to obtain complete obliteration of the shunt with transvenous sinus packing.…”