title: Characteristics and long-term outcome of 251 patients with dural arteriovenous fistulas in a defined population.
abstract: OBJECTIVE
  Management of dural arteriovenous fistulas (DAVFs) has changed during the last decades due to increased knowledge of their pathophysiology and natural history as well as advances in treatment modalities. The authors describe the characteristics and long-term outcome of a large consecutive series of patients with DAVFs.
  
  
  METHODS
  Altogether 251 patients with 261 DAVFs were treated in 2 of the 5 neurosurgery departments at Helsinki and Kuopio University Hospitals between 1944 and 2006. Clinical data and radiological examinations were reviewed to assess patients' overall long-term clinical outcome.
  
  
  RESULTS
  The detection rate of DAVFs increased markedly in the 1970s and again in the 1990s when digital subtraction angiography was introduced. The incidence of DAVFs in a defined southern Finnish population was 0.51 per 100,000 individuals per year, which represents 32% of all the brain arteriovenous malformations. In the early part of the series, DAVFs were treated by proximal ligation of the feeding arteries. Later, most of the patients underwent preoperative embolization and subsequent craniotomy, and since 2000 stereotactic radiosurgery has been increasingly used in the treatment of DAVFs. Fifty-nine percent of the 261 fistulas were totally occluded. Treatment-related major complications were seen in 21 patients.
  
  
  CONCLUSIONS
  The advances in diagnostic methods (digital subtraction angiography, CT, and MRI) increased the detection rate of DAVFs, and as treatment modalities developed, the results of treatment and outcome of patients markedly improved with the introduction of endovascular techniques and stereotactic radiosurgery. Microsurgery is of limited use in DAVFs resistant to other treatment modalities.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. anna.piippo@hus.fi
authors.forename: Anna
authors.initials: A
authors.lastname: Piippo
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
authors.forename: Jouke
authors.initials: J
authors.lastname: van Popta
authors.forename: Marko
authors.initials: M
authors.lastname: Kangasniemi
authors.forename: Jaakko
authors.initials: J
authors.lastname: Rinne
authors.forename: Juha E
authors.initials: JE
authors.lastname: Jääskeläinen
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011379:Prognosis; D016634:Radiosurgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult