Predictive factors for spontaneous resolution of dural arteriovenous fistulas: a systematic review

Abstract

Abstract Purpose The aim of this review is to offer a comprehensive overview of the existing knowledge regarding Dural Arteriovenous Fistulas (DAVFs), examining their correlation with clinical data and various pathological conditions. Materials and methods The literature was analyzed according to “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines. MR, CT images and angiography have been used to identify the signs of the presence of DAVFs and the possibility of spontaneous resolution. It is not currently believed that the resolution of DAVFs is exclusively linked to specific conditions, and evidence shows that in a proportion of patients, occlusion of these fistulas occurs without any intervention. Studies exploring the presence of DAVFs and their relationship with clinical data have revealed interesting findings. Furthermore, researchers have identified associations between DAVFs and a variety of factors such as thrombosis, architectural characteristics, angiography, hemorrhage, and more, which may promote their spontaneous closure. Results A total of 28 articles were selected. Finally, 5 studies, including 2 retrospective and 5 prospective ones, along with 21 case reports, were included in our results. Conclusions The main predictive factors for thrombosis, crucial for DAVF resolution, are stasis and endothelial damage. Stasis arises from certain DAVF architectures, cavernous sinus enlargement, or compression from hemorrhage with edema, while endothelial damage often results from contrast medium use in angiography. These factors are not always decisive, leaving the closure mechanism uncertain. Understanding these factors aids clinicians in stratifying patients and tailoring treatments. Current evidence is limited by a lack of randomized controlled trials and study heterogeneity; thus, larger, multicenter studies are needed to enhance future findings.