Acta Neurochirurgica

, 153:1273

Management, risk factors and outcome of cranial dural arteriovenous fistulae: a single-center experience

  • Stephan Dützmann
  • Jürgen Beck
  • Rüdiger Gerlach
  • Andrea Bink
  • Joachim Berkefeld
  • Richard du Mesnil de Rochement
  • Volker Seifert
  • Andreas Raabe
Clinical Article

DOI: 10.1007/s00701-011-0981-x

Cite this article as:
Dützmann, S., Beck, J., Gerlach, R. et al. Acta Neurochir (2011) 153: 1273. doi:10.1007/s00701-011-0981-x

Abstract

Background

The role of endovascular interventions in managing dural arteriovenous fistulas (DAVFs) is increasing. Furthermore, in patients with aggressive DAVFs, different surgical interventions are required for complete obliteration or disconnection. Our objective was to evaluate the management of patients with intracranial DAVFs treated in our institution to identify the parameters that may help guide the long-term management of these lesions.

Methods

The hospital records of 53 patients with intracranial DAVFs were reviewed. We then conducted a systematic telephone interview to obtain long-term follow-up information.

Results

The main presenting symptoms were tinnitus and headache. Nineteen (35%) patients presented with intracranial bleeding, 84% of patients scored between 0 and 2 using a modified Rankin Scale at the last follow-up visit. Twenty-four patients were treated surgically. Overall postoperative complications occurred in seven (29%) surgically treated patients, but only two patients permanently worsened. For patients with Borden type II and III fistulas, the annual incidence of hemorrhage was 30%. Two patients had late recurrences of surgically and endovascularly occluded DAVFs. Long-term follow-up showed that compared with spinal DAVFs, only 50% of intracranial DAVFs showed complete remission of symptoms, 41% partial remission, 6% no remission and 4% deterioration of symptoms that led to treatment of the DAVF.

Conclusion

In general, intracranial DAVFs can be successfully surgically managed by simple venous disconnection in many cases. However, half of the patients do not show complete remission of symptoms. Age and the occurrence of perioperative complication were the most important determinants of outcome.

Keywords

Dural arteriovenous fistula Endovascular treatment Surgical treatment results Intracranial hemorrhage 

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Stephan Dützmann
    • 1
  • Jürgen Beck
    • 1
  • Rüdiger Gerlach
    • 1
  • Andrea Bink
    • 2
  • Joachim Berkefeld
    • 2
  • Richard du Mesnil de Rochement
    • 2
  • Volker Seifert
    • 1
  • Andreas Raabe
    • 1
    • 3
  1. 1.Department of Neurosurgery, NeurocenterJohann Wolfgang Goethe UniversityFrankfurt am MainGermany
  2. 2.Department of Neuroradiology, NeurocenterJohann Wolfgang Goethe UniversityFrankfurt am MainGermany
  3. 3.University Department of NeurosurgeryBern University Hospital, InselspitalBernSwitzerland

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