Observation Versus Intervention for Low-Grade Intracranial Dural Arteriovenous Fistulas

Ching-Jen Chen, Thomas J Buell, Dale Ding, Ridhima Guniganti, Akash P Kansagra, Giuseppe Lanzino, Waleed Brinjikji, Louis Kim, Michael R Levitt, Isaac Josh Abecassis, Diederik Bulters, Andrew Durnford, W Christopher Fox, Adam J Polifka, Bradley A Gross, Minako Hayakawa, Colin P Derdeyn, Edgar A Samaniego, Sepideh Amin-Hanjani, Ali AlarajAmanda Kwasnicki, J Marc C van Dijk, Adriaan R E Potgieser, Robert M Starke, Stephanie Chen, Junichiro Satomi, Yoshiteru Tada, Adib Abla, Ryan R L Phelps, Rose Du, Rosalind Lai, Gregory J Zipfel, Jason P Sheehan*, Consortium for Dural Arteriovenous Fistula Outcomes Research

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: Low-grade intracranial dural arteriovenous fistulas (dAVF) have a benign natural history in the majority of cases. The benefit from treatment of these lesions is controversial.

OBJECTIVE: To compare the outcomes of observation versus intervention for low-grade dAVFs.

METHODS: We retrospectively reviewed dAVF patients from institutions participating in the CONsortium for Dural arteriovenous fistula Outcomes Research (CONDOR). Patients with low-grade (Borden type I) dAVFs were included and categorized into intervention or observation cohorts. The intervention and observation cohorts were matched in a 1:1 ratio using propensity scores. Primary outcome was modified Rankin Scale (mRS) at final follow-up. Secondary outcomes were excellent (mRS 0-1) and good (mRS 0-2) outcomes, symptomatic improvement, mortality, and obliteration at final follow-up.

RESULTS: The intervention and observation cohorts comprised 230 and 125 patients, respectively. We found no differences in primary or secondary outcomes between the 2 unmatched cohorts at last follow-up (mean duration 36 mo), except obliteration rate was higher in the intervention cohort (78.5% vs 24.1%, P < .001). The matched intervention and observation cohorts each comprised 78 patients. We also found no differences in primary or secondary outcomes between the matched cohorts except obliteration was also more likely in the matched intervention cohort (P < .001). Procedural complication rates in the unmatched and matched intervention cohorts were 15.4% and 19.2%, respectively.

CONCLUSION: Intervention for low-grade intracranial dAVFs achieves superior obliteration rates compared to conservative management, but it fails to improve neurological or functional outcomes. Our findings do not support the routine treatment of low-grade dAVFs.

Original languageEnglish
Number of pages10
JournalNeurosurgery
DOIs
Publication statusE-pub ahead of print - 13-Feb-2021

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