Long-term cognitive outcome in dural arteriovenous fistula after embolization therapy

Patients with dural arteriovenous fistulas (DAVF) suffer from cognitive impairments that go often unrecognized. This study aimed to explore the severity of cognitive impairment as well as specific cognitive domains affected in DAVF patients and to track its evolution over long-term follow-up after embolization. Consecutive DAVF patients (and an equal number of healthy controls) were prospectively enrolled and underwent a comprehensive baseline neuropsychological (NP) assessment. These patients were re-evaluated postembolization at a short-term follow-up of 1 month and long-term follow-up of 8-12 months. Thirty-one patients were included, with a male-to-female ratio of 5.2:1 and an average age of 45.1 years. NP assessments revealed significantly impaired cognitive scores across all domains (Addenbrooke's Cognitive Examination [m-ACE], the Rey Auditory Verbal Learning Test [RAVLT], the Wechsler Memory Scale, digit span forward and backward tests, and the Trail Making Test Parts A and B) in the DAVF group compared to healthy controls (p < .001). Post embolization, the m-ACE (p < .001), RAVLT (p = .04), WMS-verbal delay (p = .002) and Trail making test B (p = .019) scores showed statistically significant improvement compared to healthy controls at 1 month. However, the cognitive scores did not fully recover to the level of healthy controls at long-term follow-up. Though treatment leads to significant cognitive recovery, lasting residual cognitive deficits are persistent in DAVF patients compared to healthy controls. Inclusion of comprehensive NP evaluation in work up can unmask subtle cognitive deficits that may guide in therapeutic decision making especially in 'benign' DAVFs.