Abstract
Objective
Dural arteriovenous fistulae (DAVF) in the tentorial middle line region are uncommon with specific features and more cognitive disorders than any other region. The purpose of this study is to present clinical characteristics and our experience with endovascular treatment in this specific region.
Methods
During a 20-year period, 94.9% of patients (74/78) underwent endovascular treatment (36 in galenic, 48.6%) (12 in straight sinus, 16.2%) (26 in torcular, 35.1%). There were 63 males and 15 females with mean age of 50 (50 ± 12) years in total of 78 patients. The clinical presentation, angiographic features, treatment strategy, and clinical outcomes were recorded.
Results
Transarterial embolization (TAE) was performed in 89.2% of the 74 patients (66/74), transvenous embolization alone in one patient and mixed approach in seven. Complete obliteration of the fistulas was obtained in 87.5% of the patients (64/74). 71 patients (mean, 56 months) had phone, outpatient, or admission follow-up. The digital subtraction angiography (DSA) follow-up period (25/78, 32.1%) was 13.8 (6–21) months. Two of them (2/25, 8%) had fistula recurrences after complete embolization and were embolized again. The phone follow-up period (70/78, 89.7%) was 76.6 (40–92.3) months. Pre-embolization and post-embolization mRS ≥ 2 were in 44 patients (44/78) and 15 (15/71) patients, respectively. DAVF with internal cerebral vein drainage (OR 6.514, 95% Cl 1.201–35.317) and intracranial hemorrhage (OR 17.034, 95% Cl 1.122–258.612) during TAE were the risk factors for predicting poor outcomes (followed up mRS ≥ 2).
Conclusions
TAE is the first-line treatment for tentorial middle line region DAVF. When pial feeders’ obliteration is difficult to achieve, it should not be forced due to the poor outcomes after intracranial hemorrhage. The cognitive disorders caused by this region were not reversible as reported. It is imperative to enhance the care provided to these patients with cognitive disorders.
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Data availability
The data are available from the corresponding author on reasonable request.
Abbreviations
- DAVF:
-
Dural arteriovenous fistulae
- DSA:
-
Digital subtraction angiography
- EVT:
-
Endovascular treatment
- mRS:
-
Modified Ranking score
- OA:
-
Occipital artery
- MMA:
-
Middle meningeal artery
- PMA:
-
Posterior meningeal artery
- SCA:
-
Superior cerebellar artery
- PCA:
-
Posterior cerebral artery
- MHT:
-
Meningohypophyseal trunk
- AICA:
-
Anteroinferior cerebellar artery
- PICA:
-
Posteroinferior cerebellar artery
- AphA:
-
Ascending pharyngeal artery
- PAA:
-
Posterior auricular artery
- STA:
-
Superficial temporal artery
- ACA:
-
Anterior cerebral artery
- TAE:
-
Transarterial embolization
- TVE:
-
Transvenous embolization
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Funding
This study was funded by the National Natural Science Foundation of China (No.82101460). The role of the funding body: collection of the data.
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Conception and design: XS, YM. Acquisition of data: XS, ZS, TT, YF, XM, QG. Drafting the article: XS. Critically revising the article: YM, PZ, HZ. All the authors have read and approved the final manuscript.
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Su, X., Song, Z., Tu, T. et al. A retrospective study of 78 adult tentorial middle line region dural arteriovenous fistulae. Acta Neurol Belg 123, 1395–1404 (2023). https://doi.org/10.1007/s13760-023-02237-7
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DOI: https://doi.org/10.1007/s13760-023-02237-7