Clinical Presentation and Surgical Management of Tentorial Dural Arteriovenous Fistulae: An Analysis from the Consortium for Dural Arteriovenous Fistula Outcomes Research

Introduction: Dural arteriovenous fistulae (dAVFs) are rare cerebrovascular anomalies. One important subgroup of these lesions is tentorial dAVFs. Tentorial dAVFs are more likely to have aggressive features, making them prone to symptomatic presentations and hemorrhage. Here, we utilize an international, multicenter registry to describe the presentation of tentorial dAVFs, quantify outcomes following resection, and identify predictors for surgical outcome.

Methods: Patients were obtained from the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database. Variables analyzed included age at treatment, sex, comorbidities, clinical presentation, arterial anatomy, venous anatomy, Borden grade, and surgical approach. The primary efficacy endpoint utilized was complete surgical resection, while the primary safety endpoint was a composite endpoint including clinical complications related to the dAVF and return to the operating room for dAVF-related etiologies. To identify factors for each endpoint, a multivariable logistic regression for each endpoint was performed using stepwise backwards selection in SAS studio v3.8. The primary efficacy endpoint in our study was defined as complete surgical resection.

Results: A total of 1241 dAVFs were available for analysis in the CONDOR database, including 59 tentorial dAVFs. Presentation included hemorrhage in 61% (36/59), non-hemorrhagic neurologic deficit in 31% (18/59), flow-related symptoms in 19% (11/59), and incidental presentation in 5% (3/59) of cases. Preoperative embolization was utilized in 61% (36/59) and complete surgical resection was achieved in 83% (49/59) of patients. Multivariable analysis demonstrated that prior stroke (p = 0.04) and the presence of venous ectasia (p = 0.04) were associated with a lower likelihood of surgical success. Older age at treatment (p = 0.04) and use of antiplatelet medications (p = 0.02) were associated with the composite safety endpoint.

Conclusion: Complete surgical resection of tentorial dAVFs can be accomplished in a high number of these lesions. Surgical success was less common in patients with previous strokes and in dAVFs with venous ectasia. Older age at treatment and the use of antiplatelet medications were associated with clinical complications or return to the operating room.

Publication History

Article published online:
07 February 2025