title: Management, risk factors and outcome of cranial dural arteriovenous fistulae: a single-center experience.
abstract: BACKGROUND
  The role of endovascular interventions in managing dural arteriovenous fistulas (DAVFs) is increasing. Furthermore, in patients with aggressive DAVFs, different surgical interventions are required for complete obliteration or disconnection. Our objective was to evaluate the management of patients with intracranial DAVFs treated in our institution to identify the parameters that may help guide the long-term management of these lesions.
  
  
  METHODS
  The hospital records of 53 patients with intracranial DAVFs were reviewed. We then conducted a systematic telephone interview to obtain long-term follow-up information.
  
  
  RESULTS
  The main presenting symptoms were tinnitus and headache. Nineteen (35%) patients presented with intracranial bleeding, 84% of patients scored between 0 and 2 using a modified Rankin Scale at the last follow-up visit. Twenty-four patients were treated surgically. Overall postoperative complications occurred in seven (29%) surgically treated patients, but only two patients permanently worsened. For patients with Borden type II and III fistulas, the annual incidence of hemorrhage was 30%. Two patients had late recurrences of surgically and endovascularly occluded DAVFs. Long-term follow-up showed that compared with spinal DAVFs, only 50% of intracranial DAVFs showed complete remission of symptoms, 41% partial remission, 6% no remission and 4% deterioration of symptoms that led to treatment of the DAVF.
  
  
  CONCLUSIONS
  In general, intracranial DAVFs can be successfully surgically managed by simple venous disconnection in many cases. However, half of the patients do not show complete remission of symptoms. Age and the occurrence of perioperative complication were the most important determinants of outcome.
authors.affiliation: Department of Neurosurgery, Neurocenter, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Dützmann
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Gerlach
authors.forename: Andrea
authors.initials: A
authors.lastname: Bink
authors.forename: Joachim
authors.initials: J
authors.lastname: Berkefeld
authors.forename: Richard
authors.initials: R
authors.lastname: du Mesnil de Rochement
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis / Q000601:surgery*; D003299:Cooperative Behavior; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033183:Interdisciplinary Communication; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis*; D012008:Recurrence; D012189:Retrospective Studies