title: Predictability of the future development of aggressive behavior of cranial dural arteriovenous fistulas based on decision tree analysis.
abstract: OBJECTIVE
  The severity of clinical signs and symptoms of cranial dural arteriovenous fistulas (DAVFs) are well correlated with their pattern of venous drainage. Although the presence of cortical venous drainage can be considered a potential predictor of aggressive DAVF behaviors, such as intracranial hemorrhage or progressive neurological deficits due to venous congestion, accurate statistical analyses are currently not available. Using a decision tree data mining method, the authors aimed at clarifying the predictability of the future development of aggressive behaviors of DAVF and at identifying the main causative factors.
  
  
  METHODS
  Of 266 DAVF patients, 89 were eligible for analysis. Under observational management, 51 patients presented with intracranial hemorrhage/infarction during the follow-up period.
  
  
  RESULTS
  The authors created a decision tree able to assess the risk for the development of aggressive DAVF behavior. Evaluated by 10-fold cross-validation, the decision tree's accuracy, sensitivity, and specificity were 85.28%, 88.33%, and 80.83%, respectively. The tree shows that the main factor in symptomatic patients was the presence of cortical venous drainage. In its absence, the lesion location determined the risk of a DAVF developing aggressive behavior.
  
  
  CONCLUSIONS
  Decision tree analysis accurately predicts the future development of aggressive DAVF behavior.
authors: Departments of 1 Neurosurgery and.
authors: Junichiro
authors: J
authors: Satomi
authors: Medical Informatics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors: A Ammar
authors: AA
authors: Ghaibeh
authors: Medical Informatics, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
authors: Hiroki
authors: H
authors: Moriguchi
authors: Departments of 1 Neurosurgery and.
authors: Shinji
authors: S
authors: Nagahiro
mesh_terms: D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000453:epidemiology; D003663:Decision Trees; D005500:Follow-Up Studies; D006801:Humans; D020300:Intracranial Hemorrhages / Q000453:epidemiology; D015233:Models, Statistical; D009422:Nervous System Diseases / Q000453:epidemiology; D012307:Risk Factors; D012680:Sensitivity and Specificity
keywords: DAVF = dural arteriovenous fistula; ICH = intracerebral hemorrhage; IVH = intraventricular hemorrhage; NHND = nonhemorrhagic neurological deficit; SAH = subarachnoid hemorrhage; decision tree analysis; dural arteriovenous fistulas; predictability; vascular disorders