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Rossmann T, Veldeman M, Oulasvirta E, Nurminen V, Rauch P, Gruber A, Lehecka M, Niemelä M, Numminen J, Raj R. Long-term risk of hemorrhage and mortality after treatment of high-grade intracranial dural arteriovenous fistulas. J Neurointerv Surg 2024:jnis-2024-021688. [PMID: 38839281 DOI: 10.1136/jnis-2024-021688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/18/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Despite recent multi-institutional efforts, long-term data on clinical and radiological outcomes after treatment of high-grade dural arteriovenous fistulas (dAVFs) remain scarce. This study aimed to evaluate the long-term risk of hemorrhage and fistula-related mortality after treatment. METHODS Retrospective analysis of all consecutive patients primarily diagnosed with a high-grade dAVF (Cognard grade 2b, 2a+b, 3, 4) between January 2012 and September 2022 at a large neurovascular center. Primary endpoints were intracranial hemorrhage (ICH) and all-cause mortality after treatment; secondary endpoints were angiographic occlusion, complication rate and neurological deficits. RESULTS A total of 121 patients underwent 141 treatments (122 endovascular therapy (EVT), 5 radiotherapy, 14 surgery) of which 12 patients (10%) underwent retreatment. Follow-up was available in all patients for a median of 4.2 (IQR 2.5 to 6.6) years. Eleven patients (9%) died during the follow-up period, of which three deaths (2%) occurred after hemorrhagic presentation, one of them attributable to treatment. One death (0.8%) was due to delayed hemorrhage after partial occlusion from EVT. No other post-treatment bleedings occurred. Angiographic follow-up after multimodality treatment was available in 93% of patients after a median of 6 months; the overall occlusion rate was 90%. The overall rate of complications was 25% after EVT and 14% after surgery. The rates of new transient and permanent neurological deficits after EVT were 9% and 3%, respectively. CONCLUSIONS The long-term rate of re-bleeding or dAVF-related mortality was low when high rates of angiographic occlusion were achieved. The risk for treatment-related complications leading to neurological sequela was low.
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Affiliation(s)
- Tobias Rossmann
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Michael Veldeman
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
- Department of Neurosurgery, Universitätsklinikum Aachen, Aachen, Germany
| | - Elias Oulasvirta
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Ville Nurminen
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Philip Rauch
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Linz, Austria
- Johannes Kepler University Linz, Linz, Austria
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Jussi Numminen
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
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Ellens N, Singh AP, Santangelo G, Bender MT. Dural arteriovenous fistula embolisation with venous remodelling following venous sinus stenting. BMJ Case Rep 2024; 17:e256869. [PMID: 38191222 PMCID: PMC10806990 DOI: 10.1136/bcr-2023-256869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Abstract
We report a case of the formation of a dural arteriovenous fistula (dAVF) of the transverse-sigmoid sinus following venous sinus stenting (VSS), treated with trans-arterial embolisation and venous remodelling. An obese woman in her 30s presented with persistent daily headaches after undergoing endoscopic repair of a skull base cerebrospinal fluid leak. Angiography demonstrated a focal right transverse-sigmoid sinus stenosis, and she underwent VSS of the right transverse sinus. She developed progressive pulsatile tinnitus within 3 months, and angiography demonstrated the formation of a Borden type 1 dAVF along the stent. Trans-arterial embolisation of the dAVF was performed with venous remodelling using a Copernic RC balloon. While VSS has become a promising treatment for venous sinus stenosis and idiopathic intracranial hypertension, dAVF formation is a rare but significant potential complication. Embolisation with venous remodelling can be performed to treat these lesions.
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Affiliation(s)
- Nathaniel Ellens
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Aman Preet Singh
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Matthew T Bender
- Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
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