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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.
Abecassis, Isaac Josh; Meyer, R Michael; Levitt, Michael R; Sheehan, Jason P; Chen, Ching-Jen; Gross, Bradley A; Lockerman, Ashley; Fox, W Christopher; Brinjikji, Waleed; Lanzino, Giuseppe; Starke, Robert M; Chen, Stephanie H; Potgieser, Adriaan R E; van Dijk, J Marc C; Durnford, Andrew; Bulters, Diederik; Satomi, Junichiro; Tada, Yoshiteru; Kwasnicki, Amanda; Amin-Hanjani, Sepideh; Alaraj, Ali; Samaniego, Edgar A; Hayakawa, Minako; Derdeyn, Colin P; Winkler, Ethan; Abla, Adib; Lai, Pui Man Rosalind; Du, Rose; Guniganti, Ridhima; Kansagra, Akash P; Zipfel, Gregory J; Kim, Louis J.
Affiliation
  • Abecassis IJ; Departments of1Neurological Surgery.
  • Meyer RM; Departments of1Neurological Surgery.
  • Levitt MR; Departments of1Neurological Surgery.
  • Sheehan JP; 4Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington.
  • Chen CJ; 5Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
  • Gross BA; 5Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia.
  • Lockerman A; 6Department of Neurological Surgery, University of Pittsburgh, Pennsylvania.
  • Fox WC; 7Department of Neurosurgery, University of Florida, Gainesville, Florida.
  • Brinjikji W; 7Department of Neurosurgery, University of Florida, Gainesville, Florida.
  • Lanzino G; Departments of8Neurosurgery and.
  • Starke RM; 9Radiology, Mayo Clinic, Rochester, Minnesota.
  • Chen SH; Departments of8Neurosurgery and.
  • Potgieser ARE; 9Radiology, Mayo Clinic, Rochester, Minnesota.
  • van Dijk JMC; 10Department of Neurological Surgery, University of Miami, Florida.
  • Durnford A; 10Department of Neurological Surgery, University of Miami, Florida.
  • Bulters D; 11Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands.
  • Satomi J; 11Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands.
  • Tada Y; 12Department of Neurosurgery, University of Southampton, United Kingdom.
  • Kwasnicki A; 12Department of Neurosurgery, University of Southampton, United Kingdom.
  • Amin-Hanjani S; 13Department of Neurosurgery, Tokushima University, Tokushima, Japan.
  • Alaraj A; 13Department of Neurosurgery, Tokushima University, Tokushima, Japan.
  • Samaniego EA; 14Department of Neurosurgery, University of Illinois at Chicago, Illinois.
  • Hayakawa M; 14Department of Neurosurgery, University of Illinois at Chicago, Illinois.
  • Derdeyn CP; 14Department of Neurosurgery, University of Illinois at Chicago, Illinois.
  • Winkler E; 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
  • Abla A; 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
  • Lai PMR; 15Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
  • Du R; 16Department of Neurological Surgery, University of California, San Francisco, California.
  • Guniganti R; 16Department of Neurological Surgery, University of California, San Francisco, California.
  • Kansagra AP; 17Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and.
  • Zipfel GJ; 17Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and.
  • Kim LJ; Departments of18Neurological Surgery.
J Neurosurg ; 136(4): 971-980, 2022 04 01.
Article in En | MEDLINE | ID: mdl-34507300
ABSTRACT

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.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Intracranial Aneurysm / Central Nervous System Vascular Malformations / Embolization, Therapeutic Type of study: Observational_studies / Risk_factors_studies Limits: Humans Language: En Journal: J Neurosurg Year: 2022 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Intracranial Aneurysm / Central Nervous System Vascular Malformations / Embolization, Therapeutic Type of study: Observational_studies / Risk_factors_studies Limits: Humans Language: En Journal: J Neurosurg Year: 2022 Document type: Article