gms | German Medical Science

Objective: Dural arteriovenous fistulas (DAVFs) are complex vascular lesions. Haemorrhage or progressive neurological deficits compose the typical presentation of high-risk fistulae. Studies reporting long-term results of treatment are scarce. Here we reviewed our experience of 54 patients with DAVFs that were treated at our institution. Specifically, the rate of incomplete treatment, the event rate after incomplete treatment, the event rate after complete DAVF occlusion and the recurrence rate were of interest.

Methods: First, we retrospectively reviewed the charts of our patients with intracranial DAVFs between 1999 and 2007. Patient records, angiograms, operative reports, and clinical notes were analyzed. We then obtained late follow-up via telephone interview.

Results: Between 1999 and 2007 we treated 54 Patients at our institution. The mean age at presentation was 57 years (range 25–61). We treated 24 (53,3%) patients surgically. Overall postoperative complications occurred in 7 (29%) patients. (3 complications (12,5%) were serious). None of the postoperative complications were associated with an incomplete occlusion of the fistula. Mean follow-up time was 32 months (range 2–110 months). 7 (13%) patients were lost to follow-up. The distribution of mRS were as follows (cavernous sinus fistulas are excluded, six patients were managed conservatively): A) Pre-treatment mRS 0–2: 33 Pts. (58%); mRS 3–5: 16 Pts. (42%); B) Last follow up: mRS 0–2: 27Pts. (85%); mRS 3–5:5 Pts. (15%). Preoperative mRS, age and the occurrence of perioperative complications were important determinants of outcome. 3 patients were left with incomplete occlusion of the DAVF (One with a Borden Type III fistula who declined further treatment, two with Type I fistulas). Two additional patients had late recurrences of primarily occluded DAVFs. Of those, none had a rebleeding. During the time from diagnosis of a hemorrhagic fistula until treatment - two patients had a rebleeding. The annual incidence of rebleeding in the Borden Type II–III fistulas in the hemorrhagic subgroup was 23% (2 patients in 8,48 patient years).

Conclusions: The major determinant for hemorrhagic events, leptomeningeal venous drainage was also found in our study. Borden grade II and III DAVFs should be treated without major delay. We showed that in general DAVFs could be managed leading to a very satisfactory outcome. Preoperative Rankin-score, age and the occurrence of perioperative complications were important determinants of outcome.