Cranial Dural Arteriovenous Shunts: An Evaluation of the Outcome
Anchalee Churojana MD1, Dittapong Songsaeng MD1, Rujimas Khumtong MD1,3, Thaweesak Aurboonyawat MD2, Ekawut Chankaew MD2, Pipat Chewvit MD1, Anek Suwanbundit PhD1
Affiliation : 1 Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Department of Neurosurgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand 3 Department of Radiology, Faculty of Medicine, Songklanagarin Hospital, Prince of Songkla University, Songkhla, Thailand
Objective : To evaluate the effectiveness of the treatment of patients with cranial dural arteriovenous (cid:976)istulas [dAVFs] on long-term
follow-up and determine factors that affect the post-treatment clinical outcome.
Materials and Methods : After being certi(cid:976)ied by the Siriraj Institutional Review Board, Faculty of Medicine Siriraj Hospital, Mahidol
University, 180 patients with cranial dAVFs were retrospectively reviewed at the Interventional Neuroradiology Unit, Siriraj
Hospital, Bangkok, Thailand. There were 118 females and 62 males, age ranged from 15 to 85 years with mean age of 52.64 years.
The dAVFs were classi(cid:976)ied angiographically according to Davies’ criteria and Cognard classi(cid:976)ication into benign and aggressive
shunts. Endovascular procedure was the (cid:976)irst treatment option. Therapeutic outcomes were measured by angiographic appearances
to complete (no residual shunt or retrograde leptomeningeal venous drainage [RLVD]), partial treatment (residual RLVD), and
procedural complications. The clinical outcomes were de(cid:976)ined into favorable (cure or improved without new symptoms or disability)
and unfavorable (unchanged or worsening symptoms). Thirty-one patients (17.22%) lost to follow-up were excluded. The possible
factors that may associate with patient’s outcome were compared between favorable and unfavorable groups. Relationship between
therapeutic results and clinical outcome were analyzed.
Results : Of the 180 patients, there were 231 shunts. Multiple shunts were found at 26.11%. Thirty-nine patients (21.67%) had
aggressive symptoms (e.g., neurological de(cid:976)icit, cognitive impairment, or seizure). The most common location of dAVF was the
cavernous (55.84%), followed by transverse sigmoid sinus (27.27%) and superior sagittal sinus (7.79%) respectively. Aggressive
shunts were found at 48.33%. The abnormal image (cid:976)indings were white matter changes at 16.81%, hemorrhage at 12.39%,
hydrocephalus at 6.19%, and parenchymal calci(cid:976)ication in one patient. One hundred forty-nine patients (82.78%) who had follow-up
(ranging from 1 month to 12 years with average at 9.61 months), 136 (91.26%) had favorable outcome. For unfavorable outcome,
signi(cid:976)icant related factors were hydrocephalus (p = 0.002) and calci(cid:976)ication (p = 0.002). For favorable outcome, signi(cid:976)icant related
factors were benign symptoms (p<0.01) and no associated sinus thrombosis (p<0.01). For therapeutic results, complete treatment
achieved high favorable outcome (93.15%). Endovascular complication rate was 4.7%.
Conclusion : High favorable clinical outcome of cranial dAVF was achieved with low complication rate. Aggressive clinical and
angiographic presentations as well as intracranial venous congestion were reversible following an effective treatment. The favorable
clinical outcome is predictable in benign symptoms (p<0.01) and no associated sinus thrombosis (p<0.01). Excluding complication,
unfavorable outcome is related with ventricular dilatation (p = 0.002) and subcortical calci(cid:976)ication (p = 0.002) caused by prolong
increased intracranial pressure or chronic venous congestion. When treatment result is unresponsive, offering treatment in patients
with these factors should be reconsidered.
Keywords : Dural arteriovenous (cid:976)istula, Dural arteriovenous shunt, Symptom, Clinical outcome
