Abstract
INTRODUCTION
The rationale for treatment of dural arteriovenous fistulas (dAVF) without cortical venous reflux is symptomatic resolution. Most studies of dural arteriovenous fistula treatment, including those for stereotactic radiosurgery, have focused on angiographic obliteration instead of clinical symptomatic outcome.
METHODS
The authors evaluated their institutional experience with stereotactic radiosurgery for cerebral dAVFs without cortical venous reflux from 1991 to 2016, evaluating angiographic and clinical outcomes and focusing on the course of pulsatile tinnitus and/or ocular symptoms after treatment. They subsequently pooled their results with those published in the literature.
RESULTS
>Pooled outcomes data from 120 patients with pulsatile tinnitus and 229 patients with ocular symptoms were analyzed. Over a mean follow-up of 2.6 years, 77% of patients presenting with pulsatile tinnitus experienced resolution and an additional 21% had improvement, with an angiographic obliteration rate of 70.9%. Among 229 patients with ocular symptoms from carotid-cavernous dAVFs, improvement or resolution of symptoms occurred in 95% of those with chemosis, 90% of those with ophthalmoplegia, and 96% of those with proptosis. The angiographic obliteration rate was 76.2%. There were eight permanent complications out of 349 total treated low-risk dAVF (2.3%).
CONCLUSION
Rates of clinically-significant symptomatic improvement or resolution of symptoms referable to “low risk” dAVFs are even higher than their angiographic obliteration rate, an important factor in patient counseling and when considering the optimal treatment approach for these dAVFs.
Clinical Course of Cranial Dural Arteriovenous Fistulas With Long-Term Persistent Cortical Venous Reflux