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Endovascular treatment of 170 consecutive cranial dural arteriovenous fistulae: results and complications


Baltsavias, Gerasimos; Valavanis, Anton (2014). Endovascular treatment of 170 consecutive cranial dural arteriovenous fistulae: results and complications. Neurosurgical Review, 37(1):63-71.

Abstract

This study aims to evaluate a single-center experience with endovascular treatment of cranial dural arterievenous fistulae (CDAVF). The clinical and radiological records of 170 consecutive patients harboring a CDAVF and treated endovascularly in a 16-year period were reviewed. A variety of data related to demographics, features of the lesion, treatment, outcome, and follow-up were analyzed with emphasis to the results and complications. Half of the lesions had cortical venous drainage (CVD) in the initial angiographic investigation, whereas 26 % had exclusively CVD. Sixty-seven percent of our patients presented with benign symptoms and 33 % with aggressive symptoms. In 60.5 % of the patients with benign lesion (without CVD), an anatomic cure in the immediate postinterventional angiogram without complication or permanent morbidity was achieved, whereas 69 % of the patients with aggressive lesions (with CVD) had an anatomic cure in the postinterventional final angiogram with all permanent-morbidity cases belonging to this group. The average of endovascular operation sessions per patient was 1.2. In a mean follow-up period of 2.8 years, the overall complete occlusion rate was 85.5 % (78 % for the benign group and 89.5 % for the aggressive group) and clinical cure and/or improvement rate of 93 %. The operative mortality was zero, and permanent neurologic morbidity was 2.3 %. In 73 % of our cases, N-butyl cyanoacrylate (NBCA) was used as the only or main embolic material. Endovascular embolization is the treatment of choice for CDAVF. High rates of good anatomical and clinical results, associated with very low operative complication rate can be achieved with few embolization sessions. Although mastering of a permanent embolic material is important, the therapeutic strategy should be individulized and not material based.

Abstract

This study aims to evaluate a single-center experience with endovascular treatment of cranial dural arterievenous fistulae (CDAVF). The clinical and radiological records of 170 consecutive patients harboring a CDAVF and treated endovascularly in a 16-year period were reviewed. A variety of data related to demographics, features of the lesion, treatment, outcome, and follow-up were analyzed with emphasis to the results and complications. Half of the lesions had cortical venous drainage (CVD) in the initial angiographic investigation, whereas 26 % had exclusively CVD. Sixty-seven percent of our patients presented with benign symptoms and 33 % with aggressive symptoms. In 60.5 % of the patients with benign lesion (without CVD), an anatomic cure in the immediate postinterventional angiogram without complication or permanent morbidity was achieved, whereas 69 % of the patients with aggressive lesions (with CVD) had an anatomic cure in the postinterventional final angiogram with all permanent-morbidity cases belonging to this group. The average of endovascular operation sessions per patient was 1.2. In a mean follow-up period of 2.8 years, the overall complete occlusion rate was 85.5 % (78 % for the benign group and 89.5 % for the aggressive group) and clinical cure and/or improvement rate of 93 %. The operative mortality was zero, and permanent neurologic morbidity was 2.3 %. In 73 % of our cases, N-butyl cyanoacrylate (NBCA) was used as the only or main embolic material. Endovascular embolization is the treatment of choice for CDAVF. High rates of good anatomical and clinical results, associated with very low operative complication rate can be achieved with few embolization sessions. Although mastering of a permanent embolic material is important, the therapeutic strategy should be individulized and not material based.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neuroradiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2014
Deposited On:04 Nov 2013 08:08
Last Modified:24 Sep 2019 19:42
Publisher:Springer
ISSN:0344-5607
OA Status:Green
Publisher DOI:https://doi.org/10.1007/s10143-013-0498-2
PubMed ID:24101196

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