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

J Neurosurg. 2017 Feb;126(2):360-367. doi: 10.3171/2016.2.JNS152081. Epub 2016 Apr 29.


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.

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.

MeSH terms

  • Adult
  • Aged
  • Central Nervous System Vascular Malformations / diagnostic imaging
  • Central Nervous System Vascular Malformations / therapy*
  • Cerebral Angiography
  • Embolization, Therapeutic / adverse effects*
  • Endovascular Procedures / adverse effects*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Treatment Outcome