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Changing Clinical and Therapeutic Trends in Tentorial Dural Arteriovenous Fistulas: A Systematic Review.

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Changing Clinical and Therapeutic Trends in Tentorial Dural Arteriovenous Fistulas: A Systematic Review.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Cannizzaro, D. Brinjikji, W. Rammos, S. Murad, M. H. Lanzino, G.
Description	Author Affiliation: Cannizzaro D ( From the Departments of Neurosurgery (D.C., G.L.).); Brinjikji W ( Radiology (W.B.) brinjikji.waleed@mayo.edu.); Rammos S ( Department of Neurosurgery (S.R.), Arkansas Neuroscience Institute, Little Rock, Arkansas.); Murad MH ( Center for Science of Healthcare Delivery (M.H.M.), Mayo Clinic, Rochester, Minnesota.); Lanzino G ( From the Departments of Neurosurgery (D.C., G.L.).)
Abstract	BACKGROUND AND PURPOSE: Tentorial dural arteriovenous fistulas are characterized by a high hemorrhagic risk. We evaluated trends in outcomes and management of tentorial dural arteriovenous fistulas and performed a meta-analysis evaluating clinical and angiographic outcomes by treatment technique. MATERIALS AND METHODS: We performed a comprehensive literature search for studies on surgical and endovascular treatment of tentorial dural arteriovenous fistulas. We compared the proportion of patients undergoing endovascular, surgical, and combined endovascular/surgical management; the proportion of patients presenting with ruptured tentorial dural arteriovenous fistulas; and proportion of patients with good neurologic outcome across 3 time periods: 1980-1995, 1996-2005, and 2006-2014. We performed a random-effects meta-analysis, evaluating the rates of occlusion, long-term good neurologic outcome, perioperative morbidity, and resolution of symptoms for the 3 treatment modalities. RESULTS: Twenty-nine studies with 274 patients were included. The proportion of patients treated with surgical treatment alone decreased from 38.7% to 20.4% between 1980-1995 and 2006-2014. The proportion of patients treated with endovascular therapy alone increased from 16.1% to 48.0%. The proportion of patients presenting with ruptured tentorial dural arteriovenous fistulas decreased from 64.4% to 43.6%. The rate of good neurologic outcome increased from 80.7% to 92.9%. Complete occlusion rates were highest for patients receiving multimodality treatment (84.0%; 95% CI, 72.0%-91.0%) and lowest for endovascular treatment (71.0%; 95% CI, 56.0%-83.0%; P < .01). Long-term good neurologic outcome was highest in the endovascular group (89.0%; 95% CI, 80.0%-95.0%) and lowest for the surgical group (73.0%; 95% CI, 51.0%-87.0%; P = .03). CONCLUSIONS: Patients with tentorial dural arteriovenous fistulas are increasingly presenting with unruptured lesions, being treated endovascularly, and experiencing higher rates of good neurologic outcomes. Endovascular treatment was associated with superior neurologic outcomes but lower occlusion rates.
File Format	HTM / HTML
ISSN	01956108
e-ISSN	1936959X
Journal	American Journal of Neuroradiology
Issue Number	10
Volume Number	36
Language	English
Publisher	American Journal of Neuroradiology
Publisher Date	2015-10-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Neurology Discipline Radiology Central Nervous System Vascular Malformations Diagnosis Therapy Spinal Cord Blood Supply Angiography Dura Mater Embolization, Therapeutic Outcome And Process Assessment (health Care) Retrospective Studies Comparative Study Meta-analysis
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Neurology (clinical)

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