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 Alaraj; Amanda 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; Jay F Piccirillo; Hari Raman; Kim Lipsey; Roanna Vine; Enrico Giordan; Harry J Cloft; David F Kallmes; Bruce E Pollock; Michael J Link; Jason Sheehan; Mohana Patibandla Rao; Thomas Buell; Gabriella Paisan; R Michael Meyer; Cory Kelly; Jonathan Duffill; Adam Ditchfield; John Millar; Jason Macdonald; Dimitri Laurent; Brian Hoh; Jessica Smith; Ashley Lockerman; L Dade Lunsford; Brian T Jankowitz; Santiago Ortega Gutierrez; David Hasan; Jorge A Roa; James Rossen; Waldo Guerrero; Allen McGruder; Fady T Charbel; Victor A Aletich; Linda Rose-Finnell; Eric C Peterson; Dileep R Yavagal; Sur Samir; Yasuhisa Kanematsu; Nobuaki Yamamoto; Tomoya Kinouchi; Masaaki Korai; Izumi Yamaguchi; Yuki Yamamoto; Ethan Winkler; Ryan Phelps; Michael Lawton; Martin Rutkowski; M Ali Aziz Sultan; Nirav Patel; Kai U Frerichs; Consortium for Dural Arteriovenous Fistula Outcomes Research

doi:10.1093/neuros/nyab024

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Observation Versus Intervention for Low-Grade Intracranial Dural Arteriovenous Fistulas

Journal article

Peer reviewed

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, …

Neurosurgery, Vol.88(6), pp.1111-1120

2021-05-13

DOI: https://doi.org/10.1093/neuros/nyab024

PMID: 33582776

Abstract

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.

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.105 Strokes; 1.105.1222 Arteriovenous Malformation
Web Of Science research areas: Clinical Neurology; Surgery
ESI research areas: Clinical Medicine

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Title: Observation Versus Intervention for Low-Grade Intracranial Dural Arteriovenous Fistulas
Creators: Ching-Jen Chen - Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
Thomas J Buell - Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
Dale Ding - Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
Ridhima Guniganti - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
Akash P Kansagra - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA, Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
Giuseppe Lanzino - Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
Waleed Brinjikji - Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
Louis Kim - Department of Neurosurgery, University of Washington, Seattle, Washington, USA
Michael R Levitt - Department of Neurosurgery, University of Washington, Seattle, Washington, USA
Isaac Josh Abecassis - Department of Neurosurgery, University of Washington, Seattle, Washington, USA
Diederik Bulters - Department of Neurosurgery, University of Southampton, Southampton, United Kingdom
Andrew Durnford - Department of Neurosurgery, University of Southampton, Southampton, United Kingdom
W Christopher Fox - Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
Adam J Polifka - Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
Bradley A Gross - Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
Minako Hayakawa - Department of Radiology, University of Iowa, Iowa City, Iowa, USA
Colin P Derdeyn - Department of Radiology, University of Iowa, Iowa City, Iowa, USA
Edgar A Samaniego - Department of Radiology, University of Iowa, Iowa City, Iowa, USA
Sepideh Amin-Hanjani - Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
Ali Alaraj - Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
Amanda Kwasnicki - Department of Neurosurgery, University of Illinois, Chicago, Illinois, USA
J Marc C van Dijk - Department of Neurosurgery, University of Groningen, Groningen, the Netherlands
Adriaan R E Potgieser - Department of Neurosurgery, University of Groningen, Groningen, the Netherlands
Robert M Starke - Department of Neurosurgery, University of Miami, Miami, Florida, USA, Department of Radiology, University of Miami, Miami, Florida, USA
Stephanie Chen - Department of Neurosurgery, University of Miami, Miami, Florida, USA
Junichiro Satomi - Department of Neurosurgery, Tokushima University, Tokushima, Japan
Yoshiteru Tada - Department of Neurosurgery, Tokushima University, Tokushima, Japan
Adib Abla - Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
Ryan R L Phelps - Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
Rose Du - Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
Rosalind Lai - Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
Gregory J Zipfel - Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
Jason P Sheehan - Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
Gregory J Zipfel - Washington University in Saint Louis
Akash P Kansagra - Washington University in Saint Louis
Ridhima Guniganti - Washington University in Saint Louis
Jay F Piccirillo - Washington University in Saint Louis
Hari Raman - Washington University in Saint Louis
Kim Lipsey - Mayo Clinic
Giuseppe Lanzino - University of Virginia
Roanna Vine - University of Virginia
Enrico Giordan - University of Virginia
Waleed Brinjikji - University of Virginia
Harry J Cloft - University of Virginia
David F Kallmes - University of Virginia
Bruce E Pollock - University of Virginia
Michael J Link - University of Virginia
Jason Sheehan - University of Washington
Ching-Jen Chen - University of Washington
Mohana Patibandla Rao - University of Washington
Dale Ding - University of Washington
Thomas Buell - University of Washington
Gabriella Paisan - University of Washington
Louis Kim - Wessex Neurological Centre
Michael R Levitt - Wessex Neurological Centre
Isaac Josh Abecassis - Wessex Neurological Centre
R Michael Meyer - Wessex Neurological Centre
Cory Kelly - Wessex Neurological Centre
Diederik Bulters - University of Florida
Andrew Durnford - University of Florida
Jonathan Duffill - University of Florida
Adam Ditchfield - University of Florida
John Millar - University of Florida
Jason Macdonald - University of Florida
W Christopher Fox - University of Pittsburgh
Adam J Polifka - University of Pittsburgh
Dimitri Laurent - University of Pittsburgh
Brian Hoh - University of Pittsburgh
Jessica Smith - University of Pittsburgh
Ashley Lockerman - University of Pittsburgh
Bradley A Gross - University of Iowa
L Dade Lunsford - University of Iowa
Brian T Jankowitz - University of Iowa
Minako Hayakawa - University of Illinois, Chicago
Colin P Derdeyn - University of Illinois, Chicago
Edgar A Samaniego - University of Illinois, Chicago
Santiago Ortega Gutierrez - University of Illinois, Chicago
David Hasan - University of Illinois, Chicago
Jorge A Roa - University of Illinois, Chicago
James Rossen - University of Illinois, Chicago
Waldo Guerrero - University of Illinois, Chicago
Allen McGruder - University of Illinois, Chicago
Sepideh Amin-Hanjani - University of Groningen, University Medical Center Groningen
Ali Alaraj - University of Groningen, University Medical Center Groningen
Amanda Kwasnicki - University of Groningen, University Medical Center Groningen
Fady T Charbel - University of Groningen, University Medical Center Groningen
Victor A Aletich - University of Groningen, University Medical Center Groningen
Linda Rose-Finnell - University of Groningen, University Medical Center Groningen
J Marc C van Dijk - University of Miami
Adriaan R E Potgieser - University of Miami
Eric C Peterson - Tokushima University
Dileep R Yavagal - Tokushima University
Sur Samir - Tokushima University
Stephanie Chen - Tokushima University
Junichiro Satomi - University of California, San Francisco
Yoshiteru Tada - University of California, San Francisco
Yasuhisa Kanematsu - University of California, San Francisco
Nobuaki Yamamoto - University of California, San Francisco
Tomoya Kinouchi - University of California, San Francisco
Masaaki Korai - University of California, San Francisco
Izumi Yamaguchi - University of California, San Francisco
Yuki Yamamoto - University of California, San Francisco
Adib Abla - Brigham and Women's Hospital
Ethan Winkler - Brigham and Women's Hospital
Ryan Phelps - Brigham and Women's Hospital
Michael Lawton - Brigham and Women's Hospital
Martin Rutkowski - Brigham and Women's Hospital
Rose Du - Brigham and Women's Hospital
Rosalind Lai - Brigham and Women's Hospital
M Ali Aziz Sultan - Brigham and Women's Hospital
Nirav Patel - Brigham and Women's Hospital
Kai U Frerichs - Brigham and Women's Hospital
Consortium for Dural Arteriovenous Fistula Outcomes Research
Publication Details: Neurosurgery, Vol.88(6), pp.1111-1120
Academic Unit: Miller School of Medicine; UMMG Department of Neurology; UMMG Dept of Neurological Surgery
Language: English
Resource Type: Journal article
PMID: 33582776
Record Identifier: 991031597628402976