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Morphological, clinical, and procedural determinants of embolization outcomes in non-cavernous cerebral dural arteriovenous fistulas: A retrospective study

Year: 2026

Type: article

Abstract: PURPOSE: The purpose of this retrospective study was to determine whether dAVF (dural arteriovenous fistula) characteristics influences treatment indication, embolization techniques, complications, radiation burden, and outcome. METHODS AND MATERIALS: Patients treated by embolization for a brain dAVF were included. Excluded were cavernous sinus and surgically treated dAVF. Patients' demographics, clinical and treatment data were retrieved. dAVF clusters were formed: haemorrhagic versus non-haemorrhagic onset and sinus versus non-sinus type and impact on treatment indication, complications, radiation burden, functional and angiographic outcome was analyzed. RESULTS: In a study involving 119 dAVF in 115 patients, 33 patients (mean age 62 years ± 1.8, 72.7% males) presented with a haemorrhagic onset, while 82 (mean age 58 years ± 1.6, 57.3% females) exhibiting 86 dAVF had no bleeding. The sigmoid sinus was over-represented in the latter (52.3%), whereas a cerebrocortical occipital vein was frequently involved in the former group (27,3%). All but one haemorrhagic dAVF demonstrated a Borden-III classification. At six months, the prevalence of mRS class "0" was significantly higher in the non-haemorrhagic dAVF group (70.7% versus 32.3%) compared to the sinus-type clusters, where no such difference was observed. Six months angiography revealed occlusion in 88.2% of 102 catheterized fistulae, similar for all groups. Onyx volume and injection time was significantly higher in non-haemorrhagic and sinus-type dAVF. In non-haemorrhagic dAVF, fluoroscopy time (66.16 versus 40.48 minutes) and the number of acquisitions (68 versus 50) was significantly higher, but not radiation exposure. Although rare, mortality occurred only in sinus-type non-haemorrhagic dAVF. Facial nerve palsy was the major adverse event in non-haemorrhagic dAVF. CONCLUSION: Employing comparable techniques, occluding non-haemorrhagic onset dAVF takes longer and requires a larger embolic volume, yet it presents a higher likelihood of achieving an excellent functional outcome. Occlusion rates are high in all dAVF clusters. Managing non-haemorrhagic, sinus-type dAVFs requires careful attention.

Source: Journal of Stroke and Cerebrovascular Diseases

DOI: 10.1016/j.jstrokecerebrovasdis.2026.108763