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A retrospective study of 78 adult tentorial middle line region dural arteriovenous fistulae

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Abstract

Objective

Dural arteriovenous fistulae (DAVF) in the tentorial middle line region are uncommon with specific features and more cognitive disorders than any other region. The purpose of this study is to present clinical characteristics and our experience with endovascular treatment in this specific region.

Methods

During a 20-year period, 94.9% of patients (74/78) underwent endovascular treatment (36 in galenic, 48.6%) (12 in straight sinus, 16.2%) (26 in torcular, 35.1%). There were 63 males and 15 females with mean age of 50 (50 ± 12) years in total of 78 patients. The clinical presentation, angiographic features, treatment strategy, and clinical outcomes were recorded.

Results

Transarterial embolization (TAE) was performed in 89.2% of the 74 patients (66/74), transvenous embolization alone in one patient and mixed approach in seven. Complete obliteration of the fistulas was obtained in 87.5% of the patients (64/74). 71 patients (mean, 56 months) had phone, outpatient, or admission follow-up. The digital subtraction angiography (DSA) follow-up period (25/78, 32.1%) was 13.8 (6–21) months. Two of them (2/25, 8%) had fistula recurrences after complete embolization and were embolized again. The phone follow-up period (70/78, 89.7%) was 76.6 (40–92.3) months. Pre-embolization and post-embolization mRS ≥ 2 were in 44 patients (44/78) and 15 (15/71) patients, respectively. DAVF with internal cerebral vein drainage (OR 6.514, 95% Cl 1.201–35.317) and intracranial hemorrhage (OR 17.034, 95% Cl 1.122–258.612) during TAE were the risk factors for predicting poor outcomes (followed up mRS ≥ 2).

Conclusions

TAE is the first-line treatment for tentorial middle line region DAVF. When pial feeders’ obliteration is difficult to achieve, it should not be forced due to the poor outcomes after intracranial hemorrhage. The cognitive disorders caused by this region were not reversible as reported. It is imperative to enhance the care provided to these patients with cognitive disorders.

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Data availability

The data are available from the corresponding author on reasonable request.

Abbreviations

DAVF:

Dural arteriovenous fistulae

DSA:

Digital subtraction angiography

EVT:

Endovascular treatment

mRS:

Modified Ranking score

OA:

Occipital artery

MMA:

Middle meningeal artery

PMA:

Posterior meningeal artery

SCA:

Superior cerebellar artery

PCA:

Posterior cerebral artery

MHT:

Meningohypophyseal trunk

AICA:

Anteroinferior cerebellar artery

PICA:

Posteroinferior cerebellar artery

AphA:

Ascending pharyngeal artery

PAA:

Posterior auricular artery

STA:

Superficial temporal artery

ACA:

Anterior cerebral artery

TAE:

Transarterial embolization

TVE:

Transvenous embolization

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Funding

This study was funded by the National Natural Science Foundation of China (No.82101460). The role of the funding body: collection of the data.

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Authors and Affiliations

  1. Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 10053, China

    Xin Su, Zihao Song, Tianqi Tu, Yuxiang Fan, Xiaosheng Meng, Qingling Gao, Yongjie Ma, Peng Zhang & Hongqi Zhang

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  1. Xin Su
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  2. Zihao Song
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  3. Tianqi Tu
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  4. Yuxiang Fan
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  5. Xiaosheng Meng
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  7. Yongjie Ma
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  8. Peng Zhang
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  9. Hongqi Zhang
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Contributions

Conception and design: XS, YM. Acquisition of data: XS, ZS, TT, YF, XM, QG. Drafting the article: XS. Critically revising the article: YM, PZ, HZ. All the authors have read and approved the final manuscript.

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Correspondence to Yongjie Ma, Peng Zhang or Hongqi Zhang.

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Su, X., Song, Z., Tu, T. et al. A retrospective study of 78 adult tentorial middle line region dural arteriovenous fistulae. Acta Neurol Belg 123, 1395–1404 (2023). https://doi.org/10.1007/s13760-023-02237-7

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