Role of surgery in management of intracranial dural arteriovenous fistulas

Kang, Yusuhn; Cho, Won Sang; Lee, Sung Ho; Kim, Kang-Min; Kang, Hyun-Seung; Kim, Jeong Eun

doi:10.7461/jcen.2023.e2022.10.006

Cited by 3 publications

(2 citation statements)

References 82 publications

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“…Overall, the rate of dAVF complete obliteration after treatment among all the included patients was 71%, similar to the rates described in the literature 10–13. Endovascular embolization has become the primary treatment modality for most dAVFs; however, compared with other modalities, its advantages in relation to the specific dAVF type and patient’s baseline characteristics is not fully outlined 14 15. For instance, although the most common treatment approach in the present study was endovascular embolization (66%), patients who underwent surgery as primary treatment were more likely to have a favorable outcome and had a six-fold higher likelihood of achieving a complete dAVF obliteration.…”

Section: Discussionsupporting

confidence: 78%

The VEBAS score: a practical scoring system for intracranial dural arteriovenous fistula obliteration

Becerril-Gaitan

Ding

Ironside

et al. 2023

J NeuroIntervent Surg

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BackgroundTools predicting intracranial dural arteriovenous fistulas (dAVFs) treatment outcomes remain scarce. This study aimed to use a multicenter database comprising more than 1000 dAVFs to develop a practical scoring system that predicts treatment outcomes.MethodsPatients with angiographically confirmed dAVFs who underwent treatment within the Consortium for Dural Arteriovenous Fistula Outcomes Research-participating institutions were retrospectively reviewed. A subset comprising 80% of patients was randomly selected as training dataset, and the remaining 20% was used for validation. Univariable predictors of complete dAVF obliteration were entered into a stepwise multivariable regression model. The components of the proposed score (VEBAS) were weighted based on their ORs. Model performance was assessed using receiver operating curves (ROC) and areas under the ROC.ResultsA total of 880 dAVF patients were included. Venous stenosis (presence vs absence), elderly age (<75 vs ≥75 years), Borden classification (I vs II-III), arterial feeders (single vs multiple), and past cranial surgery (presence vs absence) were independent predictors of obliteration and used to derive the VEBAS score. A significant increase in the likelihood of complete obliteration (OR=1.37 (1.27–1.48)) with each additional point in the overall patient score (range 0–12) was demonstrated. Within the validation dataset, the predicted probability of complete dAVF obliteration increased from 0% with a 0–3 score to 72–89% for patients scoring ≥8.ConclusionThe VEBAS score is a practical grading system that can guide patient counseling when considering dAVF intervention by predicting the likelihood of treatment success, with higher scores portending a greater likelihood of complete obliteration.

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Section: Discussionsupporting

confidence: 78%

The VEBAS score: a practical scoring system for intracranial dural arteriovenous fistula obliteration

Becerril-Gaitan

Ding

Ironside

et al. 2023

J NeuroIntervent Surg

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“…Furthermore, the role of the intracranial venous system in dAVFs is often overlooked, despite its potential substantial influence on both etiology and prognosis ( 11 ). An effective preoperative evaluation of the venous system can significantly improve patient survival rates ( 12 ). In this report, we present a unique case of a dAVF leading to severe cortical venous varices, which resulted in widespread hemorrhagic lesions in both cerebral hemispheres due to CVR.…”

Section: Introductionmentioning

confidence: 99%

Complex torcular dural arteriovenous fistula leading to cortical venous reflux-induced severe varix and subsequent bilateral cerebral hemispheric hemorrhage: a case report

Li,

Hou,

Chen

et al. 2023

Front. Neurol.

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Background and importanceDural arteriovenous fistulas (dAVFs) with cortical venous reflux (CVR) are associated with a higher incidence of intracranial hemorrhage (ICH). We report a rare case of a complex torcular dAVF with severe cortical veins (CV) varix leading to extensive bilateral cerebral hemorrhages. This discovery suggests a potential new subtype of dAVF. The case underscores the necessity of a comprehensive understanding of hemodynamic changes in dAVFs and the importance of considering venous compensatory capacity in treatment. This case challenges existing classifications and treatment strategies for dAVFs, highlighting the need for further research and discussion within the neurosurgical community.Clinical presentationA 56-year-old male was admitted to the hospital presenting with dizziness, fatigue, and numbness. Brain CT scans revealed extensive bilateral cerebral hemorrhages. Digital subtraction angiography (DSA) identified a complex torcular dAVF. No cerebral sinus venous thrombosis was detected, but a venous variation in the left transverse sinus was observed. Preoperative DSA demonstrated the patient’s well-developed venous compensatory ability. Subsequently, the patient underwent transarterial embolization. The patient made a good recovery. Follow-up DSA and MR angiography at 3 months and 1 year post-treatment showed no recurrence.ConclusionDAVFs are rare lesions, prone to ICH, particularly when CVR is involved. We report a rare case of CVR with severe varix leading to hemorrhagic lesions in both cerebral hemispheres. Our aim is to alert neurosurgical colleagues worldwide to this potential new subtype and to evaluate treatment options, in order to assist those who may encounter such cases in the future.

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Treatment of Ethmoidal Dural Arteriovenous Fistulae Using Supraorbital Keyhole Subfrontal Approach

Li,

Chen,

Tseng

et al. 2024

Medicina

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Due to a unique cortical venous drainage pattern without sinus drainage, ethmoidal dural arteriovenous fistula (DAVF) are uncommon cerebral vascular lesions that carry a high risk of brain bleeding and neurologic deficit. Surgical intervention has been found to have a lower complication rate and a more satisfactory obliteration rate than endovascular treatment among the various DAVF treatment options. The supraorbital keyhole subfrontal approach is one of the least invasive and appropriate surgical techniques for addressing the anterior fossa vascular lesion in eDAVFs. We describe two men, ages 60 and 71, who underwent this surgical intervention to treat asymptomatic Cognard type IV eDAVFs. Complete obliteration with a detached fistulous point and skeletonization was accomplished with the aid of intraoperative neuronavigation. Thus, we suggest that a suitable surgical method for the treatment of eDAVFs would be to use a supraorbital keyhole subfrontal approach.

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Role of surgery in management of intracranial dural arteriovenous fistulas

Cited by 3 publications

References 82 publications

The VEBAS score: a practical scoring system for intracranial dural arteriovenous fistula obliteration

The VEBAS score: a practical scoring system for intracranial dural arteriovenous fistula obliteration

Complex torcular dural arteriovenous fistula leading to cortical venous reflux-induced severe varix and subsequent bilateral cerebral hemispheric hemorrhage: a case report

Treatment of Ethmoidal Dural Arteriovenous Fistulae Using Supraorbital Keyhole Subfrontal Approach

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