Assessing the rate, natural history, and treatment trends of intracranial aneurysms in patients with intracranial dural arteriovenous fistulas: a Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) investigation

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  • 1 Departments of Neurological Surgery,
  • | 2 Radiology, and
  • | 3 Mechanical Engineering, and
  • | 4 Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington;
  • | 5 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;
  • | 6 Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;
  • | 7 Department of Neurosurgery, University of Florida, Gainesville, Florida;
  • | 8 Departments of Neurosurgery and
  • | 9 Radiology, Mayo Clinic, Rochester, Minnesota;
  • | 10 Department of Neurological Surgery, University of Miami, Florida;
  • | 11 Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands;
  • | 12 Department of Neurosurgery, University of Southampton, United Kingdom;
  • | 13 Department of Neurosurgery, Tokushima University, Tokushima, Japan;
  • | 14 Department of Neurosurgery, University of Illinois at Chicago, Illinois;
  • | 15 Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;
  • | 16 Department of Neurological Surgery, University of California, San Francisco, California;
  • | 17 Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts; and
  • | 18 Departments of Neurological Surgery,
  • | 19 Radiology, and
  • | 20 Neurology, Washington University School of Medicine, St. Louis, Missouri
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OBJECTIVE

There is a reported elevated risk of cerebral aneurysms in patients with intracranial dural arteriovenous fistulas (dAVFs). However, the natural history, rate of spontaneous regression, and ideal treatment regimen are not well characterized. In this study, the authors aimed to describe the characteristics of patients with dAVFs and intracranial aneurysms and propose a classification system.

METHODS

The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database from 12 centers was retrospectively reviewed. Analysis was performed to compare dAVF patients with (dAVF+ cohort) and without (dAVF-only cohort) concomitant aneurysm. Aneurysms were categorized based on location as a dAVF flow-related aneurysm (FRA) or a dAVF non–flow-related aneurysm (NFRA), with further classification as extra- or intradural. Patients with traumatic pseudoaneurysms or aneurysms with associated arteriovenous malformations were excluded from the analysis. Patient demographics, dAVF anatomical information, aneurysm information, and follow-up data were collected.

RESULTS

Of the 1077 patients, 1043 were eligible for inclusion, comprising 978 (93.8%) and 65 (6.2%) in the dAVF-only and dAVF+ cohorts, respectively. There were 96 aneurysms in the dAVF+ cohort; 10 patients (1%) harbored 12 FRAs, and 55 patients (5.3%) harbored 84 NFRAs. Dural AVF+ patients had higher rates of smoking (59.3% vs 35.2%, p < 0.001) and illicit drug use (5.8% vs 1.5%, p = 0.02). Sixteen dAVF+ patients (24.6%) presented with aneurysm rupture, which represented 16.7% of the total aneurysms. One patient (1.5%) had aneurysm rupture during follow-up. Patients with dAVF+ were more likely to have a dAVF located in nonconventional locations, less likely to have arterial supply to the dAVF from external carotid artery branches, and more likely to have supply from pial branches. Rates of cortical venous drainage and Borden type distributions were comparable between cohorts. A minority (12.5%) of aneurysms were FRAs. The majority of the aneurysms underwent treatment via either endovascular (36.5%) or microsurgical (15.6%) technique. A small proportion of aneurysms managed conservatively either with or without dAVF treatment spontaneously regressed (6.2%).

CONCLUSIONS

Patients with dAVF have a similar risk of harboring a concomitant intracranial aneurysm unrelated to the dAVF (5.3%) compared with the general population (approximately 2%–5%) and a rare risk (0.9%) of harboring an FRA. Only 50% of FRAs are intradural. Dural AVF+ patients have differences in dAVF angioarchitecture. A subset of dAVF+ patients harbor FRAs that may regress after dAVF treatment.

ABBREVIATIONS

AVM = arteriovenous malformation; CONDOR = Consortium for Dural Arteriovenous Fistula Outcomes Research; dAVF = dural arteriovenous fistula; ECA = external carotid artery; FRA = flow-related aneurysm; ICA = internal carotid artery; NFRA = non–flow-related aneurysm.

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  • 1

    D’Aliberti G, Talamonti G, Cenzato M, et al. Arterial and venous aneurysms associated with arteriovenous malformations. World Neurosurg. 2015;83(2):188196.

    • Search Google Scholar
    • Export Citation
  • 2

    Yu JL, Yang S, Luo Q, et al. Endovascular treatment of intracranial ruptured aneurysms associated with arteriovenous malformations: a clinical analysis of 14 hemorrhagic cases. Interv Neuroradiol. 2011;17(1):7886.

    • Search Google Scholar
    • Export Citation
  • 3

    Amin-Hanjani S, Goodin S, Charbel FT, Alaraj A. Resolution of bilateral moyamoya associated collateral vessel aneurysms: Rationale for endovascular versus surgical intervention. Surg Neurol Int. 2014;5(4)(suppl 4):S155S160.

    • Search Google Scholar
    • Export Citation
  • 4

    He L, Gao J, Thomas AJ, et al. Disappearance of a ruptured distal flow-related aneurysm after arteriovenous malformation nidal embolization. World Neurosurg. 2015;84(5):1496.e11496.e6.

    • Search Google Scholar
    • Export Citation
  • 5

    Gross BA, Ropper AE, Du R. Cerebral dural arteriovenous fistulas and aneurysms. Neurosurg Focus. 2012;32(5):E2.

  • 6

    Onu DO, Hunn AW, Harle RA. A rare association of cerebral dural arteriovenous fistula with venous aneurysm and contralateral flow-related middle cerebral artery aneurysm. BMJ Case Rep. 2013;2013 bcr2013200764.

    • Search Google Scholar
    • Export Citation
  • 7

    Cagnazzo F, Peluso A, Vannozzi R, et al. Arterial aneurysms associated with intracranial dural arteriovenous fistulas: epidemiology, natural history, and management. A systematic review. Neurosurg Rev. 2019;42(2):277285.

    • Search Google Scholar
    • Export Citation
  • 8

    Suzuki S, Tanaka R, Miyasaka Y, et al. Dural arteriovenous malformations associated with cerebral aneurysms. J Clin Neurosci. 2000;7(suppl 1):3638.

    • Search Google Scholar
    • Export Citation
  • 9

    Kikuchi K, Kowada M. Anterior fossa dural arteriovenous malformation supplied by bilateral ethmoidal arteries. Surg Neurol. 1994;41(1):5664.

    • Search Google Scholar
    • Export Citation
  • 10

    Andersson T, Kihlström L, Söderman M. Regression of a flow-related ophthalmic artery aneurysm after treatment of a frontal DAVS. A case report. Interv Neuroradiol. 2004;10(3):265268.

    • Search Google Scholar
    • Export Citation
  • 11

    Chen Z, Zhu G, Feng H, et al. Dural arteriovenous fistula of the anterior cranial fossa associated with a ruptured ophthalmic aneurysm: case report and review of the literature. Surg Neurol. 2008;69(3):318321.

    • Search Google Scholar
    • Export Citation
  • 12

    Gács G, Viñuela F, Fox AJ, Drake CG. Peripheral aneurysms of the cerebellar arteries. Review of 16 cases. J Neurosurg. 1983;58(1):6368.

    • Search Google Scholar
    • Export Citation
  • 13

    Gilard V, Curey S, Tollard E, Proust F. Coincidental vascular anomalies at the foramen magnum: dural arteriovenous fistula and high flow aneurysm on perimedullary fistula. Neurochirurgie. 2013;59(6):210213.

    • Search Google Scholar
    • Export Citation
  • 14

    Ishikawa T, Houkin K, Tokuda K, et al. Development of anterior cranial fossa dural arteriovenous malformation following head trauma. Case report. J Neurosurg. 1997;86(2):291293.

    • Search Google Scholar
    • Export Citation
  • 15

    Kaech D, de Tribolet N, Lasjaunias P. Anterior inferior cerebellar artery aneurysm, carotid bifurcation aneurysm, and dural arteriovenous malformation of the tentorium in the same patient. Neurosurgery. 1987;21(4):575582.

    • Search Google Scholar
    • Export Citation
  • 16

    Kan P, Stevens EA, Warner J, Couldwell WT. Resolution of an anterior-inferior cerebellar artery feeding aneurysm with the treatment of a transverse-sigmoid dural arteriovenous fistula. Skull Base. 2007;17(3):205210.

    • Search Google Scholar
    • Export Citation
  • 17

    Kawaguchi S, Sakaki T, Okuno S, et al. Peripheral ophthalmic artery aneurysm. Report of two cases. J Neurosurg. 2001;94(5):822825.

  • 18

    Kirsch M, Henkes H. A ruptured intraorbital ophthalmic artery aneurysm, associated with a dural arteriovenous fistula: combined transarterial and transvenous endovascular treatment. Minim Invasive Neurosurg. 2011;54(3):128131.

    • Search Google Scholar
    • Export Citation
  • 19

    Kleinschmidt A, Sullivan TJ, Mitchell K. Intraorbital ophthalmic artery aneurysms. Clin Exp Ophthalmol. 2004;32(1):112114.

  • 20

    Ko A, Filardi T, Giussani C, et al. An intracranial aneurysm and dural arteriovenous fistula in a newborn. Pediatr Neurosurg. 2010;46(6):450456.

    • Search Google Scholar
    • Export Citation
  • 21

    Kohyama S, Yamane F, Ishihara H, et al. Rupture of an aneurysm of the superior cerebellar artery feeding a dural arteriovenous fistula. J Stroke Cerebrovasc Dis. 2015;24(5):e105e107.

    • Search Google Scholar
    • Export Citation
  • 22

    Li M, Lin N, Wu J, Liang J, He W. Multiple intracranial aneurysms associated with multiple dural arteriovenous fistulas and cerebral arteriovenous malformation. World Neurosurg. 2012;77(2):398.e11398.e15.

    • Search Google Scholar
    • Export Citation
  • 23

    Martin NA, King WA, Wilson CB, et al. Management of dural arteriovenous malformations of the anterior cranial fossa. J Neurosurg. 1990;72(5):692697.

    • Search Google Scholar
    • Export Citation
  • 24

    Meneghelli P, Pasqualin A, Lanterna LA, et al. Surgical treatment of anterior cranial fossa dural arterio-venous fistulas (DAVFs): a two-centre experience. Acta Neurochir (Wien). 2017;159(5):823830.

    • Search Google Scholar
    • Export Citation
  • 25

    Murai Y, Yamashita Y, Ikeda Y, et al. Ruptured aneurysm of the orbitofrontal artery associated with dural arteriovenous malformation in the anterior cranial fossa—case report. Neurol Med Chir (Tokyo). 1999;39(2):157160.

    • Search Google Scholar
    • Export Citation
  • 26

    Muro K, Adel JG, Gottardi-Littell NR, et al. True aneurysm on the posterior meningeal artery associated with a dural arteriovenous fistula: case report. Neurosurgery. 2010;67(3):E876E877.

    • Search Google Scholar
    • Export Citation
  • 27

    Preul M, Tampieri D, Leblanc R. Giant aneurysm of the distal anterior cerebral artery: associated with an anterior communicating artery aneurysm and a dural arteriovenous fistula. Surg Neurol. 1992;38(5):347352.

    • Search Google Scholar
    • Export Citation
  • 28

    Reinard K, Basheer A, Pabaney A, et al. Spontaneous resolution of a flow-related ophthalmic-segment aneurysm after treatment of anterior cranial fossa dural arteriovenous fistula. Surg Neurol Int. 2014;5(14)(suppl 14):S512S515.

    • Search Google Scholar
    • Export Citation
  • 29

    Rumboldt Z, Beros V, Klanfar Z. Multiple cerebral aneurysms and a dural arteriovenous fistula in a patient with polyarteritis nodosa. Case illustration. J Neurosurg. 2003;98(2):434.

    • Search Google Scholar
    • Export Citation
  • 30

    Sanchis JF, Orozco M, Cabanes J. Spontaneous extradural haematomas. J Neurol Neurosurg Psychiatry. 1975;38(6):577580.

  • 31

    Sato K, Shimizu T, Fukuhara T, Namba Y. Ruptured anterior communicating artery aneurysm associated with anterior cranial fossa dural arteriovenous fistula—case report. Neurol Med Chir (Tokyo). 2011;51(1):4044.

    • Search Google Scholar
    • Export Citation
  • 32

    Brown RD Jr, Broderick JP. Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurol. 2014;13(4):393404.

    • Search Google Scholar
    • Export Citation
  • 33

    Salahuddin H, Siddiqui NS, Castonguay AC, et al. Recent trends in electively treated unruptured intracranial aneurysms. J Stroke Cerebrovasc Dis. 2019;28(7):20112017.

    • Search Google Scholar
    • Export Citation
  • 34

    Müller TB, Vik A, Romundstad PR, Sandvei MS. Risk factors for unruptured intracranial aneurysms and subarachnoid hemorrhage in a prospective population-based study. Stroke. 2019;50(10):29522955.

    • Search Google Scholar
    • Export Citation
  • 35

    Qureshi AI, Suarez JI, Parekh PD, et al. Risk factors for multiple intracranial aneurysms. Neurosurgery. 1998;43(1):2227.

  • 36

    Cagnazzo F, Brinjikji W, Lanzino G. Arterial aneurysms associated with arteriovenous malformations of the brain: classification, incidence, risk of hemorrhage, and treatment-a systematic review. Acta Neurochir (Wien). 2016;158(11):20952104.

    • Search Google Scholar
    • Export Citation
  • 37

    Redekop G, TerBrugge K, Montanera W, Willinsky R. Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage. J Neurosurg. 1998;89(4):539546.

    • Search Google Scholar
    • Export Citation
  • 38

    Martínez-Pérez R, Tsimpas A, Ruiz Á, et al. Spontaneous regression of a true intracanalicular fusiform ophthalmic artery aneurysm after endovascular treatment of an associated dural arteriovenous fistula. World Neurosurg. 2018;119:362365.

    • Search Google Scholar
    • Export Citation
  • 39

    Guniganti R, Giordan E, Chen CJ, et al. Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR): rationale, design, and initial characterization of patient cohort. J Neurosurg. Published online September 10, 2021. doi:10.3171/2021.1.JNS202790

    • Search Google Scholar
    • Export Citation

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