Low-Grade cavernous sinus dural arteriovenous fistulas derive greater benefit from treatment than Non-Cavernous sinus lesions

Current evidence suggests that low-grade intracranial dural arteriovenous fistulas (DAVFs) generally follow a benign clinical course. However, due to differences in study populations and institutional expertise, recommendations regarding the treatment of low grade DAVFs remain inconsistent. Some studies advocate for intervention, while others do not. In addition, limited research exists on whether achieving complete obliteration is necessary in the management of low-grade DAVFs.

We retrospectively reviewed patients with low-grade DAVFs from the Dural Arteriovenous Fistula Research and Management in China (DREAM-INI) database. Patients with low-grade DAVFs were included and classified into intervention or observation cohorts, as well as into complete or partial occlusion groups, cavernous sinus and non-cavernous sinus groups, among others. Further subgroup analyses and propensity score matching were also performed. The primary comparison focused on their clinical outcomes.

A total of 327 patients with low-grade DAVFs were identified. The mean age was 52.0 ± 13.2 years, and 55.4% were female. Among the 304 patients (93.0%) who received treatment, 99.3% underwent primarily endovascular embolization. We found no significant differences in clinical outcomes between the treatment and observation cohorts at the last follow-up, even after propensity score matching. However, among patients in the treatment group, complete obliteration and cavernous sinus DAVF were associated with significantly greater symptomatic improvement compared to partial obliteration and non-cavernous sinus DAVF. Progression to high grade DAVF was documented in 0.7% of DAVFs.

Among treated patients, complete fistula obliteration and cavernous sinus DAVF are associated with better symptomatic improvement compared to partial embolization and non-cavernous sinus DAVF.