Treatment Outcomes According to Various Treatment Modalities for Intracranial Dural Arteriovenous Fistulas in the Onyx Era: A 10-Year Single-Center Experience

• Published in: World neurosurgery 2019-06, Vol.126, p.e825-e834
• Main Authors: Oh, Sol Hooy, Choi, Jai Ho, Kim, Bum-Soo, Lee, Kwan Sung, Shin, Yong Sam
• Format: Article
• Language: English
• Subjects: Adult; Aged; Central Nervous System Vascular Malformations - diagnostic imaging; Central Nervous System Vascular Malformations - surgery; Central Nervous System Vascular Malformations - therapy; Cerebral Angiography; Dural arteriovenous fistula; Embolization; Embolization, Therapeutic; Endovascular Procedures - methods; Female; Humans; Male; Middle Aged; Polyvinyls - therapeutic use; Radiosurgery; Retrospective Studies; Surgery; Treatment Outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.02.173

Although transarterial embolization (TAE) with Onyx has become popular for the treatment of dural arteriovenous fistulas (DAVFs), transvenous embolization (TVE), surgery, and radiosurgery have continued to have a role. The aim of the present study was to compare the treatment outcomes stratified by the different treatment modalities. The data from 92 patients with DAVFs treated from January 2009 to June 2018 were retrospectively reviewed. The treatment strategies were decided by a multidisciplinary team according to the patient's clinical status and angiographic findings. The clinical and radiologic data were analyzed and correlated with the treatment modality. A total of 101 procedures were performed in the 92 patients. TAE, TVE, surgery, and radiosurgery were performed in 31, 49, 12, and 9 procedures, respectively. Complete and near complete occlusion was achieved in 13 cases treated with TAE (41.9%), 41 treated with TVE (83.7%), and 10 with surgery (83.3%), as shown on immediate postprocedural angiography (P < 0.001). Retreatment was needed in 9 patients in the TAE group and none in the TVE or surgery groups (P < 0.001). Surgery (n = 1), TVE (n = 3), TAE (n = 1), and radiosurgery (n = 4) were used for patients requiring retreatment. At the last follow-up examination (mean, 26.5 ± 23.9 months), 66 of 72 DAVFs (91.6%) showed angiographic complete occlusion. Clinically, the initial symptoms had disappeared or improved in 87 of 90 patients (96.7%) at the last follow-up evaluation (mean, 26.4 ± 26.8 months). Even in the Onyx era, other treatment modalities still have important roles, as shown in the present study. Therefore, the selection of the appropriate treatment modality should be individualized by the angiographic findings and clinical symptoms.