gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

High success rate for the treatment of aggressive dural arteriovenous fistulas by an interdisciplinary approach

Ein interdisziplinäres Konzept in der Behandlung hochgradiger duraler arteriovenöser Fisteln zeigt gute Erfolge

Meeting Abstract

  • corresponding author D. Miller - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • U. Sure - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • W. Tirakotai - Klinik für Neurochirurgie, Philipps-Universität Marburg
  • S. Bien - Abteilung für Neuroradiologie, Philipps-Universität Marburg
  • H. Bertalanffy - Klinik für Neurochirurgie, Philipps-Universität Marburg

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc11.05.-09.02

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgnc2005/05dgnc0212.shtml

Veröffentlicht: 4. Mai 2005

© 2005 Miller et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

Dural arteriovenous fistulas (dAVFs) are rare lesions that account for 10 to 15% of all intracranial arteriovenous malformations. Lesions that drain directly or indirectly into cortical veins (2b, 3, 4 according to the Cognard classification) are considered as clinically aggressive because they bear a high risk of bleeding. The aim of the study was to analyse presenting symptoms, differential therapy, occlusion rates and clinical outcome in patients with high grade dAVFs.

Methods

In a retrospective analysis of 45 patients admitted to our institution between 1997 and 2004 we identified 30 patients with high grade dAVFs. Eighteen of our 30 patients were treated surgically, 15 of them underwent presurgical embolization. Ten patients were treated by embolization alone and 2 patients by intraoperative interventional therapy. Eighteen of the 30 patients presented with intracranial bleeding or other aggressive neurological symptoms.

Results

A complete occlusion rate was achieved in 12/18 surgical cases (66.67%), 3/10 interventional patients (30%), and 2/2 intraoperative interventional cases (100%), respectively. The AV shunt was reduced to a lower grade in 2 of 18 surgical (11.11%) and 3 of 10 interventional cases (30%) without complete occlusion of the fistula. Clinical symptoms improved in 15/18 (83.33%), 6/10 (60%), and 2/2 (100%) patients, respectively. Two patients with severe intracerebral haemorrhage died despite surgical evacuation. One individual treated by embolization died of a postinterventional intracerebral haemorrhage.

Conclusions

A complete occlusion was achieved in 17/27 survivors (62.96%). Clinical symptoms improved in 23/27 cases (85.19%). A high success rate for the treatment of aggressive dAVFs can be achieved by an interdisciplinary approach.