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Complication rate, cure rate, and long-term outcomes of microsurgery for intracranial dural arteriovenous fistulae: a multicenter series and systematic review

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Abstract

Although microsurgery is an established treatment modality for intracranial dural arteriovenous fistula (dAVF), data regarding the perioperative complication rate, cure rate, and long-term outcomes remain scarce. The aims of this study were to describe our original experience with microsurgery, including the surgical complications and pitfalls, and conduct a systematic review of the relevant literature. A multicenter cohort of patients with dAVF treated by microsurgery was retrospectively assessed. In addition, the PubMed database was searched for published studies involving microsurgery for dAVF, and the complication rate, cure rate, and long-term outcomes were estimated. The total number of patients in our multicenter series and published articles was 553 (593 surgeries). The overall rates of transient complications, permanent complications, death, and incomplete treatment were 11.4, 4.0, 1.2, and 6.5%, respectively. A favorable outcome was achieved for 90.1% patients, even though almost half of the patients presented with intracranial hemorrhage. Of note, the incidence of recurrence was only one per 8241 patient-months of postoperative follow-up. Surgeries for anterior cranial fossa dAVF were associated with a lower complication rate, whereas those for tentorial dAVF were associated with higher complication and incomplete treatment rates. The complication and incomplete treatment rates were lower with simple disconnection of cortical venous drainage than with radical occlusion/resection of dural shunts. Our findings suggest that the cure rate, complication rates, and outcomes of microsurgery for dAVF are acceptable; thus, it could be a feasible second-line treatment option for dAVF. However, surgeons should be aware of the specific adverse events of microsurgery.

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Authors and Affiliations

  1. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan

    Taku Sugiyama, Naoki Nakayama, Ken Kazumata, Michinari Okamoto & Toshiya Osanai

  2. Department of Neurosurgery, Hokkaido Medical Center, Sapporo, Japan

    Satoshi Ushikoshi & Yusuke Shimoda

  3. Department of Neurosurgery, Kushiro Rosai Hospital, Kushiro, Japan

    Masaki Ito

  4. Department of Neurosurgery, Teine Keijinkai Medical Center, Sapporo, Japan

    Kazuki Uchida, Daisuke Shimbo & Katsuyuki Asaoka

  5. Department of Neurosurgery, Kashiwaba Neurosurgical Hospital, Sapporo, Japan

    Yasuhiro Ito

  6. Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan

    Toshitaka Nakamura

  7. Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan

    Satoshi Kuroda

  8. Department of Emergent Neurocognition, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan

    Kiyohiro Houkin

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  1. Taku Sugiyama
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Correspondence to Taku Sugiyama.

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Sugiyama, T., Nakayama, N., Ushikoshi, S. et al. Complication rate, cure rate, and long-term outcomes of microsurgery for intracranial dural arteriovenous fistulae: a multicenter series and systematic review. Neurosurg Rev 44, 435–450 (2021). https://doi.org/10.1007/s10143-019-01232-y

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