title: Changing Clinical and Therapeutic Trends in Tentorial Dural Arteriovenous Fistulas: A Systematic Review.
abstract: OBJECTIVE
  Tentorial dural arteriovenous fistulas are characterized by a high hemorrhagic risk. We evaluated trends in outcomes and management of tentorial dural arteriovenous fistulas and performed a meta-analysis evaluating clinical and angiographic outcomes by treatment technique.
  
  
  METHODS
  We performed a comprehensive literature search for studies on surgical and endovascular treatment of tentorial dural arteriovenous fistulas. We compared the proportion of patients undergoing endovascular, surgical, and combined endovascular/surgical management; the proportion of patients presenting with ruptured tentorial dural arteriovenous fistulas; and proportion of patients with good neurologic outcome across 3 time periods: 1980-1995, 1996-2005, and 2006-2014. We performed a random-effects meta-analysis, evaluating the rates of occlusion, long-term good neurologic outcome, perioperative morbidity, and resolution of symptoms for the 3 treatment modalities.
  
  
  RESULTS
  Twenty-nine studies with 274 patients were included. The proportion of patients treated with surgical treatment alone decreased from 38.7% to 20.4% between 1980-1995 and 2006-2014. The proportion of patients treated with endovascular therapy alone increased from 16.1% to 48.0%. The proportion of patients presenting with ruptured tentorial dural arteriovenous fistulas decreased from 64.4% to 43.6%. The rate of good neurologic outcome increased from 80.7% to 92.9%. Complete occlusion rates were highest for patients receiving multimodality treatment (84.0%; 95% CI, 72.0%-91.0%) and lowest for endovascular treatment (71.0%; 95% CI, 56.0%-83.0%; P < .01). Long-term good neurologic outcome was highest in the endovascular group (89.0%; 95% CI, 80.0%-95.0%) and lowest for the surgical group (73.0%; 95% CI, 51.0%-87.0%; P = .03).
  
  
  CONCLUSIONS
  Patients with tentorial dural arteriovenous fistulas are increasingly presenting with unruptured lesions, being treated endovascularly, and experiencing higher rates of good neurologic outcomes. Endovascular treatment was associated with superior neurologic outcomes but lower occlusion rates.
authors: From the Departments of Neurosurgery (D.C., G.L.).
authors: D
authors: D
authors: Cannizzaro
authors: Radiology (W.B.) brinjikji.waleed@mayo.edu.
authors: W
authors: W
authors: Brinjikji
authors: Department of Neurosurgery (S.R.), Arkansas Neuroscience Institute, Little Rock, Arkansas.
authors: S
authors: S
authors: Rammos
authors: Center for Science of Healthcare Delivery (M.H.M.), Mayo Clinic, Rochester, Minnesota.
authors: M H
authors: MH
authors: Murad
authors: From the Departments of Neurosurgery (D.C., G.L.).
authors: G
authors: G
authors: Lanzino
mesh_terms: D000792:Angiography; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000628:therapy*; D004388:Dura Mater / Q000098:blood supply / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*