title: Endovascular therapy of low- and intermediate-grade intracranial lateral dural arteriovenous fistulas: a detailed analysis of primary success rates, complication rates, and long-term follow-up of different technical approaches.
abstract: OBJECTIVE Sinus-preserving (SP) embolization techniques augment endovascular treatment options for intracranial lateral dural arteriovenous fistulas (DAVFs). The authors aimed to perform a retrospective comparison of their primary success rates, complication rates, and long-term follow-up with those of sinus-occluding (SO) treatment variants in the collective of low- and intermediate-grade lateral DAVFs (Cognard Types I-IIb). METHODS Clinical symptoms, complication rates, and Cognard grading prior to and after endovascular DAVF treatment using different technical approaches was retrospectively analyzed in 36 patients with lateral DAVF Cognard Types I-IIb. The long-term success rate was determined by a standardized questionnaire. RESULTS The SO approaches offered a higher rate of definitive fistula occlusion (93% SO vs 71% SP) but were accompanied by a significantly higher complication rate (33% or 20% SO vs 0% SP). The patients interviewed reported very high satisfaction with their health in long-term follow-up in both groups. CONCLUSIONS A higher rate of definitive fistula occlusion in the SO group was attained at the price of a significantly higher complication rate. The SP approaches offered a good primary success rate in combination with a very low complication rate. Despite some limitations of the data (e.g., a small sample size) the authors thus recommend an SP variant as the primary therapeutic option for the endovascular treatment of low- and intermediate-grade DAVFs. The SO approaches should be restricted to cases in which SP treatment does not achieve a downgrading to no worse than Cognard Type IIa.
authors.affiliation: Department of Neuroradiology, Institute of Clinical Radiology.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Ertl
authors.affiliation: Department of Neuroradiology, Institute of Clinical Radiology.
authors.forename: Hartmut
authors.initials: H
authors.lastname: Brückmann
authors.affiliation: Department of Neurosurgery, and.
authors.forename: Mathias
authors.initials: M
authors.lastname: Kunz
authors.affiliation: Institute for Medical Informatics, Biometry, and Epidemiology (IBE), University of Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Crispin
authors.affiliation: Department of Neuroradiology, Institute of Clinical Radiology.
authors.forename: Gunther
authors.initials: G
authors.lastname: Fesl
mesh_terms: D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: CCA = common carotid artery; CCF = carotid cavernous fistula; CSOE = combined sinus-occluding embolization; CSPE = combined sinus-preserving embolization; DAVF = dural arteriovenous fistula; DSA = digital subtraction angiography; ECA = external carotid artery; SO = sinus-occluding; SP = sinus-preserving; TAE = transarterial embolization; TVE = transvenous embolization; endovascular treatment; interventional neurosurgery; intracranial fistula; therapy assessment