Dural Arteriovenous Fistulas With Cognitive Impairment: Angiographic Characteristics and Treatment Outcomes

Author:

Sanchez Sebastian1,Wendt Linder2,Hayakawa Minako3,Chen Ching-Jen4,Sheehan Jason P.5,Kim Louis J.6,Abecassis Isaac Josh6,Levitt Michael R.6,Meyer R. Michael6,Guniganti Ridhima7,Kansagra Akash P.8,Lanzino Giuseppe9,Giordan Enrico9,Brinjikji Waleed10,Bulters Diederik O.11,Durnford Andrew11,Fox W. Christopher12,Smith Jessica13,Polifka Adam J.13,Gross Bradley14,Amin-Hanjani Sepideh1516,Alaraj Ali15,Kwasnicki Amanda15,Starke Robert M.17,Chen Stephanie H.17,van Dijk J. Marc C.18,Potgieser Adriaan R. E.18,Satomi Junichiro19,Tada Yoshiteru19,Phelps Ryan20,Abla Adib20,Winkler Ethan20,Du Rose21,Rosalind Lai Pui Man21,Ortega-Gutierrez Santiago1322,Zipfel Gregory J.7,Derdeyn Colin2,Samaniego Edgar A.1322ORCID

Affiliation:

1. Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA;

2. Institute for Clinical and Translational Science, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA;

3. Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA;

4. Department of Neurosurgery, The University of Texas Health Science Center at Houston, Houston, Texas, USA;

5. Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA;

6. Department of Neurosurgery, University of Washington, Seattle, Washington, USA;

7. Department of Neurosurgery, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA;

8. Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA;

9. Department of Neurosurgery, Mayo Clinic Hospital, Rochester, Minnesota, USA;

10. Department of Radiology, Mayo Clinic Hospital, Rochester, Minnesota, USA;

11. Department of Neurosurgery, University Hospital Southampton, NHS Foundation Trust, Southampton, UK;

12. Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA;

13. Department of Neurosurgery, University of Florida, Gainesville, Florida, USA;

14. Department of Neurosurgery, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA;

15. Department of Neurosurgery, University of Illinois Chicago, Chicago, Illinois, USA;

16. Department of Neurosurgery, University Hospitals Cleveland Medical Center/Case Western Reserve University School of Medicine, Cleveland, Ohio, USA

17. Department of Neurosurgery, University of Miami, Coral Gables, Florida, USA;

18. Department of Neurosurgery, University of Groningen, Groningen, Netherlands;

19. Department of Neurosurgery, Tokushima University Hospital, Tokushima, Japan;

20. Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA;

21. Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA;

22. Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA;

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.

Funder

NIH Blueprint for Neuroscience Research

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

Reference32 articles.

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