Tentorial Dural Arteriovenous Fistulas: A Retrospective Cohort Study

With advancements in endovascular techniques, an increasing number of tentorial dural arteriovenous fistulas (TDAVFs) can now be successfully treated with endovascular intervention alone. In this study, we present a summary of one single-center experience in the treatment of TDAVFs, along with a subgroup analysis based on the Lawton classification.

We conducted a retrospective review of patients with TDAVF treated at a single center over a 21-year period. Patients with TDAVFs were included and categorized into 6 types. Patient demographics and angiographic data were recorded. Postprocedural and follow-up angiographic and clinical outcomes were assessed.

A total of 275 cases of TDAVFs involving the Galenic, straight sinus, torcular, tentorial sinus, petrosal, or incisural regions were recorded in the database. Of the total cases, 236 of DAVFs (85.8%) occurred in male patients, with a mean age of 51.1 ± 11.6 years. In 245 cases (92.8%), fistulas were complete occluded immediately using various modalities, with a treatment-related complication rate of 12.5%. Galenic, straight sinus, and torcular DAVFs had higher incidence of internal cerebral vein drainage ( P < .001). Superior petrosal sinus DAVF shows a higher incidence of perimedullary venous drainage ( P < .001) and a relatively higher proportion of microsurgical treatments compared with other types ( P < .001). Galenic DAVFs had a lower immediate complete occlusion rate compared with other types of TDAVFs ( P = .013). Both Galenic and superior petrosal sinus DAVFs exhibited a higher complication rate compared with other types of TDAVFs ( P = .008). Torcular DAVFs had a tendency to develop new fistulas after treatment ( P = .008).

We present the characteristics of 275 patients with TDAVFs, predominantly middle-aged men. Most TDAVFs can be effectively treated with an endovascular approach, superior petrosal sinus DAVFs more often require microsurgical intervention.