Abstract
Dural arteriovenous fistulae (dAVF) with direct cortical venous drainage (CVD, Borden
Type III) have a high risk of hemorrhage, particularly when symptomatic. Stereotactic
radiosurgery is therefore not recommended, and endovascular treatment can be limited
by access, incomplete obliteration, and recanalization. Of 70 cerebral dAVF seen at
our institution over the past 8 years, 35 were Borden Type III (50%). Twenty-four were treated via microsurgery (69%).
Presentation included hemorrhage in nine patients (38%), nonhemorrhagic neurologic
deficits in five (21%), asymptomatic in five (21%), headache in three (13%), and seizure
in two patients (8%). Only eight of 19 patients with symptomatic dAVF were independent
(modified Rankin Scale [mRS] 0–2) preoperatively (42%). The dAVF location was tentorial
in six patients (25%), petrosal in six (25%), superior sagittal sinus in four (17%),
torcular in two (7%), floor of the anterior fossa in two (7%), and sphenoid ridge,
transverse-sigmoid, inferior sagittal sinus and jugular in one patient each (4%).
Four patients had failed endovascular therapy (17%). The angiographic obliteration
rate was 96%. The combined permanent morbidity and mortality rate was 17%. After a
mean follow-up of 2.1 years, 13 patients improved (54%), seven were the same, (29%) and four were worse
(17%). Thirteen patients were asymptomatic (mRS 0, 54%), and 18 were independent (mRS
0–2, 75%). Our results reinforce that surgical treatment of dAVF with direct CVD is
associated with a high angiographic cure rate with acceptable morbidity and mortality,
particularly in light of the lesions’ natural history.
Keywords
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Article info
Publication history
Accepted:
December 1,
2012
Received:
October 29,
2012
Identification
Copyright
© 2013 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
