title: Early and long-term excess mortality in 227 patients with intracranial dural arteriovenous fistulas.
abstract: OBJECTIVE
  The aim of this study was to assess the early and long-term excess mortality in patients with intracranial dural arteriovenous fistula (DAVF) compared with a matched general Finnish population in an unselected, population-based series.
  
  
  METHODS
  The authors identified 227 patients with DAVFs admitted to 2 of the 5 Departments of Neurosurgery in Finland--Helsinki and Kuopio University Hospitals--between 1944 and 2006. All patients were followed until death or the end of 2009. Long-term excess mortality was estimated using the relative survival ratio compared with the general Finnish population matched by age, sex, and calendar year.
  
  
  RESULTS
  The median follow-up period was 10 years (range 0-44 years). Two-thirds (67%) of the DAVFs were located in the region of transverse and sigmoid sinuses. Cortical venous drainage (CVD) was present in 28% of the DAVFs (18% transverse and sigmoid sinus, 42% others). Of the 61 deaths counted, 11 (18%) were during the first 12 months and were mainly caused by treatment complications (5 of 11, 45%). The 1-year survivors presenting with hemorrhage experienced excess mortality until 7 years from admission. However, DAVFs with CVD were associated with significant, continuous excess mortality. There were more cerebrovascular and cardiovascular deaths in this group of patients than expected in the general Finnish population. Location other than transverse and sigmoid sinuses was also associated with excess mortality.
  
  
  CONCLUSIONS
  In the patients with DAVF there was excess mortality during the first 12 months, mainly due to treatment complications. Thereafter, their overall long-term survival became similar to that of the matched general population. However, DAVFs with CVD and those located in regions other than transverse and sigmoid sinuses were associated with marked long-term excess mortality after the first 12 months.
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: Aki
authors.initials: A
authors.lastname: Laakso
authors.forename: Karri
authors.initials: K
authors.lastname: Seppä
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
authors.forename: Mika
authors.initials: M
authors.lastname: Niemelä
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000401:mortality* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors; D055815:Young Adult