Stereotactic Radiosurgery for High-Grade Intracranial Dural Arteriovenous Fistulas

World Neurosurg. 2018 Aug;116:e640-e648. doi: 10.1016/j.wneu.2018.05.062. Epub 2018 May 17.

Abstract

Objective: Factors associated with favorable outcome after stereotactic radiosurgery (SRS) for dural arteriovenous fistulas (DAVFs) with cortical venous reflux (CVR) are not completely understood. The aim of this retrospective cohort study was to assess the outcomes after SRS for high-grade DAVFs and identify predictors.

Methods: We performed a retrospective review of consecutive patients with high-grade DAVFs, defined as the presence of CVR, who underwent SRS between 1989 and 2017. The primary outcome was defined as DAVF obliteration without a new permanent neurologic deficit. Predictors of outcomes were determined using multivariate logistic regression.

Results: The study cohort was composed of 41 high-grade DAVF patients with a mean age of 52 years. DAVF obliteration without a new permanent neurologic deficit was achieved in 62% of patients (13/21). The rates of complete obliteration and new permanent neurologic deficit were 63% (17/27) and 23% (7/30) of patients, respectively. No independent predictors of the primary outcome or angiographic obliteration were identified in the multivariate model. Presentation with a nonhemorrhagic neurologic deficit (NHND) was found to be an independent predictor of a new permanent neurologic deficit after SRS (odds ratio, 14.176; 95% confidence interval, 1.119-179.540; P = 0.041).

Conclusions: Obliteration without a new permanent neurologic deficit can be achieved in most appropriately selected patients with high-grade DAVFs after treatment with SRS. NHND at presentation is a risk factor for new permanent neurologic deficit after SRS.

Keywords: Dural arteriovenous fistula; Fistula; Hemorrhage; Intracranial; Obliteration; Radiosurgery.

MeSH terms

  • Adult
  • Aged
  • Central Nervous System Vascular Malformations / complications
  • Central Nervous System Vascular Malformations / diagnostic imaging
  • Central Nervous System Vascular Malformations / surgery*
  • Cohort Studies
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Nervous System Diseases / etiology
  • Radiosurgery / methods*
  • Severity of Illness Index