Characteristics and long-term outcome of 251 patients with dural arteriovenous fistulas in a defined population

Clinical article

Anna Piippo M.D. 1 , Mika Niemelä M.D., Ph.D. 1 , Jouke van Popta M.D. 1 , Marko Kangasniemi M.D., Ph.D. 2 , Jaakko Rinne M.D., Ph.D. 3 , Juha E. Jääskeläinen M.D., Ph.D. 3 and Juha Hernesniemi M.D., Ph.D. 1
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  • 1 Departments of Neurosurgery and
  • 2 Radiology, Helsinki University Central Hospital, Helsinki; and
  • 3 Department of Neurosurgery, KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
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Object

Management of dural arteriovenous fistulas (DAVFs) has changed during the last decades due to increased knowledge of their pathophysiology and natural history as well as advances in treatment modalities. The authors describe the characteristics and long-term outcome of a large consecutive series of patients with DAVFs.

Methods

Altogether 251 patients with 261 DAVFs were treated in 2 of the 5 neurosurgery departments at Helsinki and Kuopio University Hospitals between 1944 and 2006. Clinical data and radiological examinations were reviewed to assess patients' overall long-term clinical outcome.

Results

The detection rate of DAVFs increased markedly in the 1970s and again in the 1990s when digital subtraction angiography was introduced. The incidence of DAVFs in a defined southern Finnish population was 0.51 per 100,000 individuals per year, which represents 32% of all the brain arteriovenous malformations. In the early part of the series, DAVFs were treated by proximal ligation of the feeding arteries. Later, most of the patients underwent preoperative embolization and subsequent craniotomy, and since 2000 stereotactic radiosurgery has been increasingly used in the treatment of DAVFs. Fifty-nine percent of the 261 fistulas were totally occluded. Treatment-related major complications were seen in 21 patients.

Conclusions

The advances in diagnostic methods (digital subtraction angiography, CT, and MRI) increased the detection rate of DAVFs, and as treatment modalities developed, the results of treatment and outcome of patients markedly improved with the introduction of endovascular techniques and stereotactic radiosurgery. Microsurgery is of limited use in DAVFs resistant to other treatment modalities.

Abbreviations used in this paper:AVM = arteriovenous malformation; CCA = common carotid artery; CVD = cortical venous drainage; DAVF = dural arteriovenous fistula; DSA = digital subtraction angiography; ECA = external carotid artery; GOS = Glasgow Outcome Scale; ICA = internal carotid artery; ICH = intracerebral hemorrhage; NBCA = N-butyl cyanoacrylate; PVA = polyvinyl alcohol; SAH = subarachnoid hemorrhage; SRS = stereotactic radiosurgery.

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Contributor Notes

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 December 21, 2012; DOI: 10.3171/2012.11.JNS111604.

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