Early and long-term excess mortality in 227 patients with intracranial dural arteriovenous fistulas

Clinical article

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Object

The aim of this study was to assess the early and long-term excess mortality in patients with intracranial dural arteriovenous fistula (DAVF) compared with a matched general Finnish population in an unselected, population-based series.

Methods

The authors identified 227 patients with DAVFs admitted to 2 of the 5 Departments of Neurosurgery in Finland—Helsinki and Kuopio University Hospitals—between 1944 and 2006. All patients were followed until death or the end of 2009. Long-term excess mortality was estimated using the relative survival ratio compared with the general Finnish population matched by age, sex, and calendar year.

Results

The median follow-up period was 10 years (range 0–44 years). Two-thirds (67%) of the DAVFs were located in the region of transverse and sigmoid sinuses. Cortical venous drainage (CVD) was present in 28% of the DAVFs (18% transverse and sigmoid sinus, 42% others). Of the 61 deaths counted, 11 (18%) were during the first 12 months and were mainly caused by treatment complications (5 of 11, 45%). The 1-year survivors presenting with hemorrhage experienced excess mortality until 7 years from admission. However, DAVFs with CVD were associated with significant, continuous excess mortality. There were more cerebrovascular and cardiovascular deaths in this group of patients than expected in the general Finnish population. Location other than transverse and sigmoid sinuses was also associated with excess mortality.

Conclusions

In the patients with DAVF there was excess mortality during the first 12 months, mainly due to treatment complications. Thereafter, their overall long-term survival became similar to that of the matched general population. However, DAVFs with CVD and those located in regions other than transverse and sigmoid sinuses were associated with marked long-term excess mortality after the first 12 months.

Abbreviations used in this paper:CVD = cortical venous drainage; DAVF = dural arteriovenous fistula; RSR = relative survival ratio.

Article Information

Address correspondence to: Anna Piippo, M.D., Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland. email: anna.piippo@hus.fi.

Please include this information when citing this paper: published online April 19, 2013; DOI: 10.3171/2013.3.JNS121547.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Graph showing cumulative RSRs with 95% CI in 227 patients with DAVFs as a function of follow-up period in years.

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    Graphs showing cumulative RSRs in 216 1-year survivors with DAVFs: 60 patients presenting with CVD and 145 without (A); 30 patients with ruptured and 183 with unruptured DAVFs (B); and 154 patients with DAVFs in the area of transverse and sigmoid sinuses and 62 with DAVFs in other locations (C), as a function of follow-up period in years with 95% CIs.

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