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Abecassis IJ, Meyer RM, Levitt MR, Sheehan JP, Chen CJ, Gross BA, Lockerman A, Fox WC, Brinjikji W, Lanzino G, Starke RM, Chen SH, Potgieser ARE, van Dijk JMC, Durnford A, Bulters D, Satomi J, Tada Y, Kwasnicki A, Amin-Hanjani S, Alaraj A, Samaniego EA, Hayakawa M, Derdeyn CP, Winkler E, Abla A, Lai PMR, Du R, Guniganti R, Kansagra AP, Zipfel GJ, Kim LJ. Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation. J Neurosurg 2021; 136:971-980. [PMID: 34507300 DOI: 10.3171/2021.1.jns202861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non-flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected. RESULTS Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%). CONCLUSIONS Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%-5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.
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Affiliation(s)
| | | | - Michael R Levitt
- Departments of1Neurological Surgery.,4Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
| | - Jason P Sheehan
- 5Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Ching-Jen Chen
- 5Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Bradley A Gross
- 6Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Ashley Lockerman
- 7Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - W Christopher Fox
- 7Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Waleed Brinjikji
- Departments of8Neurosurgery and.,9Radiology, Mayo Clinic, Rochester, Minnesota
| | - Giuseppe Lanzino
- Departments of8Neurosurgery and.,9Radiology, Mayo Clinic, Rochester, Minnesota
| | - Robert M Starke
- 10Department of Neurological Surgery, University of Miami, Florida
| | - Stephanie H Chen
- 10Department of Neurological Surgery, University of Miami, Florida
| | - Adriaan R E Potgieser
- 11Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - J Marc C van Dijk
- 11Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Andrew Durnford
- 12Department of Neurosurgery, University of Southampton, United Kingdom
| | - Diederik Bulters
- 12Department of Neurosurgery, University of Southampton, United Kingdom
| | - Junichiro Satomi
- 13Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Yoshiteru Tada
- 13Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Amanda Kwasnicki
- 14Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | | | - Ali Alaraj
- 14Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Edgar A Samaniego
- 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Minako Hayakawa
- 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Colin P Derdeyn
- 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Ethan Winkler
- 16Department of Neurological Surgery, University of California, San Francisco, California
| | - Adib Abla
- 16Department of Neurological Surgery, University of California, San Francisco, California
| | - Pui Man Rosalind Lai
- 17Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and
| | - Rose Du
- 17Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and
| | | | - Akash P Kansagra
- Departments of18Neurological Surgery.,20Neurology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Louis J Kim
- Departments of1Neurological Surgery.,2Radiology, and.,4Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
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Abstract
BACKGROUND Pial arterial supplies are sometimes found in patients with dural arteriovenous fistulas (DAVFs), though their characteristics have rarely been clarified. OBJECTIVE To investigate the characteristics of pial arterial supplies in DAVFs and to discuss their pathophysiology and treatment. METHODS Two hundred four consecutive patients with intracranial DAVFs over 11 yr were retrospectively reviewed. Clinical factors and radiological findings, including the presence of pial arterial supplies, were evaluated. Supply from a pial artery was classified into 2 categories: dilated pre-existing dural branches of pial arteries, and a "pure" pial supply. RESULTS Twenty-three of 204 patients (11.3%) showed an additional pial arterial supply. Multivariate analysis identified 3 independent predictors of a pial arterial supply: younger age (P < .0005), DAVF within the tentorium (P = .0162), and presence of venous dilatation (P = .0001). A dilated pre-existing dural branch of a pial artery was identified in 17 patients, while 8 had a pure pial supply. Of these 23 patients, 17 underwent interventional therapy. No postoperative intracranial hemorrhage or infarction occurred in patients with pial arterial supplies. CONCLUSION An additional pial supply is not uncommon in DAVFs and may be explained by a rich physiological pial arterial supply to the dura mater from the posterior circulation, while potential angiogenesis due to venous hypertension remains speculative. Prior to interventional treatment for DAVFs, recognition of a pial arterial supply to the DAVF might influence the treatment strategy and could help avoid inadvertent retrograde embolization of brain supplying vessels through the pial network.
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Affiliation(s)
- Takahiro Osada
- Division of Neuroradiology, Joint Depa-rtment of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Timo Krings
- Division of Neuroradiology, Joint Depa-rtment of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Sun S, Ji Y, Ji W, Liu A, Wu Z. De novo aneurysm formation of a feeder artery after embolization of a dural arteriovenous fistula and rupture during second embolization. Interv Neuroradiol 2018; 24:435-439. [PMID: 29788813 DOI: 10.1177/1591019918768565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Hemorrhage during embolization of dural arteriovenous fistula (DAVF) is a rare but devastating complication. This study was undertaken to analyze the causes of hemorrhage and avoid complication. Methods The clinical data of a case of DAVF with hemorrhagic complication were retrospectively collected and analyzed. Results The patient in this case presented with DAVF and two de novo aneurysms of a feeder artery after the first embolization. One de novo aneurysm ruptured during the second embolization of the DAVF because of hemodynamic change. Computed tomography showed a subdural hematoma, and surgical exploration was emergently performed. However, the patient died at postoperative day 10. Conclusions De novo aneurysm of a feeder artery may form after embolization of DAVF because of hemodynamic change. It has a high risk of rupture and should be a primary consideration in embolization of DAVF.
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Affiliation(s)
- Shouyuan Sun
- 1 Department of Neurosurgery, Lanzhou University Second Hospital, Gansu, China
| | - Yongping Ji
- 2 Department of Cardiovascular Medicine, Yulin No. 2 Hospital, Shaanxi, China
| | - Wenjun Ji
- 3 Department of Neurosurgery, Yulin No. 2 Hospital, Shaanxi, China
| | - Aihua Liu
- 4 Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongxue Wu
- 4 Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Arterial aneurysms associated with intracranial dural arteriovenous fistulas: epidemiology, natural history, and management. A systematic review. Neurosurg Rev 2017; 42:277-285. [PMID: 29177821 DOI: 10.1007/s10143-017-0929-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/21/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
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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