Endovascular treatment strategy and clinical outcome of tentorial dural arteriovenous fistula

Guangjian Zhang; Weiwei Zhang; Hanxiao Chang; Yuqi Shen; Chencheng Ma; Lei Mao; Zheng Li; Hua Lu

doi:10.3389/fneur.2023.1315813

Endovascular treatment strategy and clinical outcome of tentorial dural arteriovenous fistula

Front Neurol. 2024 Feb 2:14:1315813. doi: 10.3389/fneur.2023.1315813. eCollection 2023.

Authors

Guangjian Zhang^#¹, Weiwei Zhang^#², Hanxiao Chang^{3

4}, Yuqi Shen^{3

4}, Chencheng Ma^{3

4}, Lei Mao^{3

4}, Zheng Li^{3

4}, Hua Lu^{3

4}

Affiliations

¹ Department of Emergency, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
² Department of Ophthalmology, Third Medical Center of Chinese PLA General Hospital, Beijing, China.
³ Department of Neurosurgery, Jiangsu Province Hospital, Nanjing, China.
⁴ Department of Neurosurgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.

^# Contributed equally.

Abstract

Introduction: To evaluate treatment strategies and clinical outcomes following endovascular embolization of tentorial dural arteriovenous fistulas.

Methods: We retrospectively analyzed 19 patients with tentorial dural arteriovenous fistulas admitted to the Department of Neurosurgery at Jiangsu Provincial People's Hospital between October 2015 and May 2022, all treated with endovascular therapy. To collect and analyze patients' clinical presentation, imaging data, postoperative complications, and prognosis and to analyze the safety and clinical outcomes of endovascular treatment of tentorial dural arteriovenous fistulas.

Results: Imaging cure was achieved in 18 patients, with the arterial route chosen for embolization in 17 patients and the venous route in one patient; one patient received partial embolization. Staged embolization was performed in four patients. At postoperative follow-up of 9-83 months (37.8 ± 21.2), all 19 patients had recovered well (mRS score ≤ 2). Three patients experienced perioperative complications: intraoperative Onyx reflux into the middle cerebral artery in one patient; postoperative permanent limited left visual field loss and deafness in the left ear in one patient; and transient diplopia, vertigo, and decreased pain and temperature sensation of the left limb in one patient, with no abnormalities on post-procedure magnetic resonance examinations. A total of 17 patients completed a postoperative digital subtraction angiography review during follow-up, and one patient had a recurrence of an arteriovenous fistula.

Conclusion: Endovascular treatment of tentorial dural arteriovenous fistulas is safe and effective. Reduction of the Borden or Cognard classification via eliminating cortical venous reflux through multi-staged embolization or combined open surgery is a reasonable goal of treatment where complete obliteration of the fistula is not achievable.

Keywords: arteriovenous fistulas; endovascular treatment; outcome; strategy; tentorial.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by grants from the Postgraduate Research and Practice Innovation Program of Jiangsu Province (no. JX10213876).