Dural Arteriovenous Fistulas With Cognitive Impairment: Angiographic Characteristics and Treatment Outcomes

被引：3

作者：

Sanchez, Sebastian ^{[1
]}

Wendt, Linder ^{[2
]}

Hayakawa, Minako ^{[3
]}

Chen, Ching-Jen ^{[5
]}

Sheehan, Jason P. ^{[6
]}

Kim, Louis J. ^{[7
]}

Abecassis, Isaac Josh ^{[7
]}

Levitt, Michael R. ^{[7
]}

Meyer, R. Michael ^{[7
]}

Guniganti, Ridhima ^{[8
]}

Kansagra, Akash P. ^{[9
]}

Lanzino, Giuseppe ^{[10
]}

Giordan, Enrico ^{[10
]}

Brinjikji, Waleed ^{[11
]}

Bulters, Diederik O. ^{[12
]}

Durnford, Andrew ^{[12
]}

Fox, W. Christopher ^{[13
]}

Smith, Jessica ^{[14
]}

Polifka, Adam J. ^{[14
]}

Gross, Bradley ^{[15
]}

Amin-Hanjani, Sepideh ^{[16
,22
]}

Alaraj, Ali ^{[16
]}

Kwasnicki, Amanda ^{[16
]}

Starke, Robert M. ^{[17
]}

Chen, Stephanie H. ^{[17
]}

van Dijk, J. Marc C. ^{[18
]}

Potgieser, Adriaan R. E. ^{[18
]}

Satomi, Junichiro ^{[19
]}

Tada, Yoshiteru ^{[19
]}

Phelps, Ryan ^{[20
]}

Abla, Adib ^{[20
]}

Winkler, Ethan ^{[20
]}

Du, Rose ^{[21
]}

Rosalind Lai, Pui Man ^{[21
]}

Ortega-Gutierrez, Santiago ^{[1
,3
,4
]}

Zipfel, Gregory J. ^{[8
]}

Derdeyn, Colin ^{[2
]}

Samaniego, Edgar A. ^{[1
,3
,4
,23
]}

机构：

[1] Univ Iowa Hosp & Clin, Dept Neurol, Iowa City, IA USA

[2] Univ Iowa Hosp & Clin, Inst Clin & Translat Sci, Iowa City, IA USA

[3] Univ Iowa Hosp & Clin, Dept Radiol, Iowa City, IA USA

[4] Univ Iowa Hosp & Clin, Dept Neurosurg, Iowa City, IA USA

[5] Univ Texas Hlth Sci Ctr Houston, Dept Neurosurg, Houston, TX USA

[6] Univ Virginia Hlth Syst, Dept Neurosurg, Charlottesville, VA USA

[7] Univ Washington, Dept Neurosurg, Seattle, WA USA

[8] Washington Univ, Dept Neurosurg, Sch Med St Louis, St Louis, MO USA

[9] Washington Univ, Mallinckrodt Inst Radiol, Sch Med St Louis, St Louis, MO USA

[10] Mayo Clin Hosp, Dept Neurosurg, Rochester, MN USA

[11] Mayo Clin Hosp, Dept Radiol, Rochester, MN USA

[12] Univ Hosp Southampton, NHS Fdn Trust, Dept Neurosurg, Southampton, England

[13] Mayo Clin, Dept Neurosurg, Jacksonville, FL USA

[14] Univ Florida, Dept Neurosurg, Gainesville, FL USA

[15] Univ Pittsburgh, Dept Neurosurg, Med Ctr Hlth Syst, Pittsburgh, PA USA

[16] Univ Illinois, Dept Neurosurg, Chicago, IL USA

[17] Univ Miami, Dept Neurosurg, Coral Gables, FL USA

[18] Univ Groningen, Dept Neurosurg, Groningen, Netherlands

[19] Tokushima Univ Hosp, Dept Neurosurg, Tokushima, Japan

[20] Univ Calif San Francisco, Dept Neurosurg, San Francisco, CA USA

[21] Brigham & Womens Hosp, Dept Neurosurg, Boston, MA USA

[22] Case Western Reserve Univ, Univ Hosp Cleveland Med Ctr, Dept Neurosurg, Sch Med, Cleveland, OH USA

[23] Univ Iowa, Dept Neurol Neurosurg & Radiol, 200 Hawkins Dr, Iowa City, IA 52246 USA

来源：

NEUROSURGERY | 2024年 / 94卷 / 05期

关键词：

Dementia; Fistula; Intervention; POSTERIOR-FOSSA; DEMENTIA; CLASSIFICATION; PARKINSONISM; THALAMUS; NUCLEUS;

D O I：

10.1227/neu.0000000000002802

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND AND OBJECTIVES: Anecdotal cases of rapidly progressing dementia in patients with dural arteriovenous fistulas (dAVFs) have been reported in small series. However, large series have not characterized these dAVFs. We conducted an analysis of the largest cohort of dAVFs presenting with cognitive impairment (dAVFs-CI), aiming to provide a detailed characterization of this subset of dAVFs. METHODS: Patients with dAVFs-CI were analyzed from the CONDOR Consortium, a multicenter repository comprising 1077 dAVFs. A propensity score matching analysis was conducted to compare dAVFs-CI with Borden type II and type III dAVFs without cognitive impairment (controls). Logistic regression was used to identify angiographic characteristics specific to dAVFs-CI. Furthermore, post-treatment outcomes were analyzed. RESULTS: A total of 60 patients with dAVFs-CI and 60 control dAVFs were included. Outflow obstruction leading to venous hypertension was observed in all dAVFs-CI. Sinus stenosis was significantly associated with dAVFs-CI (OR 2.85, 95% CI: 1.16-7.55, P = .027). dAVFs-CI were more likely to have a higher number of arterial feeders (OR 1.56, 95% CI 1.22-2.05, P < .001) and draining veins (OR 2.05, 95% CI 1.05-4.46, P = .004). Venous ectasia increased the risk of dAVFs-CI (OR 2.38, 95% CI 1.13-5.11, P = .024). A trend toward achieving asymptomatic status at follow-up was observed in patients with successful closure of dAVFs (OR 2.86, 95% CI 0.85-9.56, P = .09) CONCLUSION: Venous hypertension is a key angiographic feature of dAVFs-CI. Moreover, these fistulas present at a mean age of 58 years-old, and exhibit a complex angioarchitecture characterized by an increased number of arteriovenous connections and stenosed sinuses. The presence of venous ectasia further exacerbates the impaired drainage and contributes to the development of dAVFs-CI. Notably, in certain cases, closure of the dAVF has the potential to reverse symptoms.

引用

页码：1035 / 1043

页数：9

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