Article
Treatment of intracranial dural arteriovenous-fistulas: A comparison of surgical versus endovascular therapy
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Published: | April 28, 2011 |
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Objective: A comparison of the clinical and radiological outcome after surgical or endovascular therapy of intracranial dural arteriovenous-fistulas (DAV-fistulas).
Methods: A retrospective analysis of 20 patients with an intracranial DAV fistula between 2003 and 2010 with respect to radiological and clinical outcome.
Results: According to the Cognard classification, 1 patient (5%) had type I, 5 patients (25%) had type IIb, 4 patients (20%) had type III, 9 patients (45%) had type IV and 1 patient (5%) had type V DAV. 10 of these patients were primarily treated by an endovascular approach with complete closure in 5 cases. 10 patients had a primary surgical treatment with complete closure in 7 cases. Thus, in 8 patients the initial closure of the fistula was incomplete. These patients underwent a secondary surgical therapy with complete closure. There was no difference in clinical outcome between both therapy modalities if an initial closure of the fistula was achieved. All patients showed neurological improvement in case of complete closure of the fistulas.
Conclusions: A higher rate of successful closure could be achieved in the primarily surgically treated cases. All patients who showed an incomplete closure of the fistula were successfully treated by a secondary surgical procedure. Therefore, a primary surgical treatment for intracranial DAVs is recommended.