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Arterial aneurysms associated with intracranial dural arteriovenous fistulas: epidemiology, natural history, and management. A systematic review

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Abstract

Arterial aneurysms are uncommon among patients with dural arteriovenous fistulae (DAVFs), and there is limited information available to guide treatment decisions in such cases. We performed a systematic review of the literature, including a case of a DAVF associated with a flow-related intraorbital ophthalmic artery (OA) aneurysm that we have recently managed. The purpose of our study was to clarify epidemiology, natural history, and management of these lesions. A total of 43 published cases of DAVF associated aneurysms were found in 26 studies on the topic. Anterior cranial fossa was the most common location (40%), and ethmoidal branches were the most common arterial feeders (55%). In about 63% of cases, the aneurysm was located on artery unrelated to DAVF supply. Approximately 10% of intracranial DAVFs were associated with aneurysms located in the intraorbital OA. Overall, 70% of lesions were Borden type III, and 50% of patients presented with hemorrhage. In approximately 17% of cases, the source of bleeding was a feeding artery aneurysm. All of the reported intraorbital OA aneurysms associated with DAVFs remained stable during follow-up. DAVF associated aneurysms are fairly rare. Anterior cranial fossa location and direct cortical venous drainage are common among these lesions. The aneurysms are less likely to be located on feeding arteries, and hemorrhagic presentation related to flow-related aneurysm rupture is uncommon.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy

    Federico Cagnazzo, Andrea Peluso, Riccardo Vannozzi & Paolo Perrini

  2. Departments of Neurologic Surgery and Radiology, Mayo Clinic, Mayo Medical School, Rochester, MN, USA

    Waleed Brinjikji & Giuseppe Lanzino

Authors
  1. Federico Cagnazzo
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  2. Andrea Peluso
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  3. Riccardo Vannozzi
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  4. Waleed Brinjikji
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  5. Giuseppe Lanzino
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  6. Paolo Perrini
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Corresponding author

Correspondence to Federico Cagnazzo.

Ethics declarations

This work was performed ethically and complies with the ethical standards of our Institutional Review Board.

Conflict of interest

Dr.Cagnazzo, Dr. Peluso, Dr. Vannozzi, Dr. Brinjikji, and Dr. Perrini certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Dr. Lanzino reports being a consultant for Covidien/Medtronic.

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Electronic supplementary material

Supplemental Figure 1

PRISMA diagram detailing the specifics of the systematic literature review. (GIF 17 kb).

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Supplemental Table 1

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Supplemental Table 2

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Cagnazzo, F., Peluso, A., Vannozzi, R. et al. Arterial aneurysms associated with intracranial dural arteriovenous fistulas: epidemiology, natural history, and management. A systematic review. Neurosurg Rev 42, 277–285 (2019). https://doi.org/10.1007/s10143-017-0929-6

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  • DOI: https://doi.org/10.1007/s10143-017-0929-6

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