Clinical and angiographic results of patients with dural arteriovenous fistula

Abstract

Endovascular embolization has been regarded as the primary treatment for dural arteriovenous fistula (dAVF). The aim of this study was to describe our experience with treatment and outcomes for patients with dural AVF, and to determine optimal treatment modalities. Between November 2007 and March 2011, 43 patients with dAVF (14 cavernous sinus, 20 transverse-sigmoid sinus, and nine patients with other types) were admitted to our Institute for treatment. For cavernous sinus dAVF, transvenous embolization was attempted as the first-line treatment with residual AVF obliterated by transarterial embolization (TAE), except for three patients who were treated conservatively. For transverse-sigmoid sinus dAVF, TAE was the primary treatment method. Nine of 14 (64.3%) patients with cavernous sinus dAVF had complete angiographic resolution. For transverse-sigmoid sinus dAVF, 14 of 17 (82.4%) patients were treated by TAE using Onyx Liquid Embolic System (eV3 Neurovascular, Irvine, CA, USA). Nine of these patients (64.3%) were angiographically cured or improved clinically with no serious complications, and the other five (35.7%) patients showed significant reductions in arteriovenous shunt. The other nine dAVF were treated by TAE or surgical disconnection depending upon the accessibility of the lesion and risk of complications. Six of nine (66.7%) patients had complete angiographic obliteration or clinical improvement. With developments in diagnostic tools and endovascular interventions, dAVF have become an important neurovascular issue. The results of this study suggest that a new approach to treatment of dAVF is needed.