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Dural Arteriovenous Fistulas With Cognitive Impairment: Angiographic Characteristics and Treatment Outcomes.
Sanchez, Sebastian; Wendt, Linder; Hayakawa, Minako; Chen, Ching-Jen; Sheehan, Jason P; Kim, Louis J; Abecassis, Isaac Josh; Levitt, Michael R; Meyer, R Michael; Guniganti, Ridhima; Kansagra, Akash P; Lanzino, Giuseppe; Giordan, Enrico; Brinjikji, Waleed; Bulters, Diederik O; Durnford, Andrew; Fox, W Christopher; Smith, Jessica; Polifka, Adam J; Gross, Bradley; Amin-Hanjani, Sepideh; Alaraj, Ali; Kwasnicki, Amanda; Starke, Robert M; Chen, Stephanie H; van Dijk, J Marc C; Potgieser, Adriaan R E; Satomi, Junichiro; Tada, Yoshiteru; Phelps, Ryan; Abla, Adib; Winkler, Ethan; Du, Rose; Rosalind Lai, Pui Man; Ortega-Gutierrez, Santiago; Zipfel, Gregory J; Derdeyn, Colin; Samaniego, Edgar A.
Afiliação
  • Sanchez S; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Wendt L; Institute for Clinical and Translational Science, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Hayakawa M; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Chen CJ; Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
  • Sheehan JP; Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
  • Kim LJ; Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
  • Abecassis IJ; Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
  • Levitt MR; Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
  • Meyer RM; Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
  • Guniganti R; Department of Neurosurgery, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA.
  • Kansagra AP; Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA.
  • Lanzino G; Department of Neurosurgery, Mayo Clinic Hospital, Rochester, Minnesota, USA.
  • Giordan E; Department of Neurosurgery, Mayo Clinic Hospital, Rochester, Minnesota, USA.
  • Brinjikji W; Department of Radiology, Mayo Clinic Hospital, Rochester, Minnesota, USA.
  • Bulters DO; Department of Neurosurgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK.
  • Durnford A; Department of Neurosurgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK.
  • Fox WC; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
  • Smith J; Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
  • Polifka AJ; Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
  • Gross B; Department of Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
  • Amin-Hanjani S; Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA.
  • Alaraj A; Department of Neurosurgery, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
  • Kwasnicki A; Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA.
  • Starke RM; Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA.
  • Chen SH; Department of Neurosurgery, University of Miami, Coral Gables, Florida, USA.
  • van Dijk JMC; Department of Neurosurgery, University of Miami, Coral Gables, Florida, USA.
  • Potgieser ARE; Department of Neurosurgery, University of Groningen, Groningen, Netherlands.
  • Satomi J; Department of Neurosurgery, University of Groningen, Groningen, Netherlands.
  • Tada Y; Department of Neurosurgery, Tokushima University Hospital, Tokushima, Japan.
  • Phelps R; Department of Neurosurgery, Tokushima University Hospital, Tokushima, Japan.
  • Abla A; Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.
  • Winkler E; Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.
  • Du R; Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.
  • Rosalind Lai PM; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Ortega-Gutierrez S; Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  • Zipfel GJ; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Derdeyn C; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
  • Samaniego EA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
Neurosurgery ; 2023 Dec 14.
Article em En | MEDLINE | ID: mdl-38095434
ABSTRACT
BACKGROUND AND

OBJECTIVES:

Anecdotal cases of rapidly progressing dementia in patients with dural arteriovenous fistulas (dAVFs) have been reported in small series. However, large series have not characterized these dAVFs. We conducted an analysis of the largest cohort of dAVFs presenting with cognitive impairment (dAVFs-CI), aiming to provide a detailed characterization of this subset of dAVFs.

METHODS:

Patients with dAVFs-CI were analyzed from the CONDOR Consortium, a multicenter repository comprising 1077 dAVFs. A propensity score matching analysis was conducted to compare dAVFs-CI with Borden type II and type III dAVFs without cognitive impairment (controls). Logistic regression was used to identify angiographic characteristics specific to dAVFs-CI. Furthermore, post-treatment outcomes were analyzed.

RESULTS:

A total of 60 patients with dAVFs-CI and 60 control dAVFs were included. Outflow obstruction leading to venous hypertension was observed in all dAVFs-CI. Sinus stenosis was significantly associated with dAVFs-CI (OR 2.85, 95% CI 1.16-7.55, P = .027). dAVFs-CI were more likely to have a higher number of arterial feeders (OR 1.56, 95% CI 1.22-2.05, P < .001) and draining veins (OR 2.05, 95% CI 1.05-4.46, P = .004). Venous ectasia increased the risk of dAVFs-CI (OR 2.38, 95% CI 1.13-5.11, P = .024). A trend toward achieving asymptomatic status at follow-up was observed in patients with successful closure of dAVFs (OR 2.86, 95% CI 0.85-9.56, P = .09).

CONCLUSION:

Venous hypertension is a key angiographic feature of dAVFs-CI. Moreover, these fistulas present at a mean age of 58 years-old, and exhibit a complex angioarchitecture characterized by an increased number of arteriovenous connections and stenosed sinuses. The presence of venous ectasia further exacerbates the impaired drainage and contributes to the development of dAVFs-CI. Notably, in certain cases, closure of the dAVF has the potential to reverse symptoms.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Neurosurgery Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Estados Unidos
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Neurosurgery Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Estados Unidos