Multiple synchronous intracranial dural arteriovenous fistulas

Area of Science:

• Neurosurgery
• Neuroradiology
• Vascular Neurology

Background:

• Intracranial multiple dural arteriovenous fistulas (DAVFs) are rare and poorly understood.
• Existing reports are limited, hindering comprehensive analysis of their characteristics and outcomes.

Purpose of the Study:

• To conduct a comparative analysis of angiographic features, clinical presentations, and outcomes of multiple intracranial DAVFs.
• To identify predictors of disease progression in patients with multiple DAVFs.

Main Methods:

• Retrospective data collection from the Dural Arteriovenous Fistula Research and Management in China (DREAM-INI) database.
• Classification of lesions as multifocal or diffuse, and progressive or non-progressive based on angiographic findings.
• Comparison of multiple versus single DAVFs and investigation of progression predictors.

Main Results:

• Diffuse-type multiple DAVFs were associated with younger age, sinus involvement, pial artery supply, venous congestion, and lower obliteration rates.
• Progressive DAVFs were linked to younger age, sinus-type, diffuse lesions, pial supply, deep venous drainage, and venous congestion.
• Multiple DAVFs showed lower good outcome rates and higher fistula-related death incidence compared to single DAVFs; younger age predicted progression.

Conclusions:

• Diffuse and progressive DAVFs predominantly affect younger individuals, often presenting with sinus-type fistulas and venous hypertension.
• Disease progression in multiple DAVFs may be driven by neoangiogenesis.
• Treatment strategies for refractory DAVFs should prioritize managing venous hypertension and improving cerebral hemodynamics over complete obliteration.