Clinical Features, Treatment, and Outcomes of Lateral Sinus Dural Arteriovenous Fistulas: A Cohort Study of 231 Patients.

BACKGROUND AND

OBJECTIVES

Lateral sinus dural arteriovenous fistulas (LS-DAVFs) are the most common type of DAVF; however, research on LS-DAVFs remains limited. This study summarizes our center's experience in treating LS-DAVFs and discusses the associated characteristics and treatment strategies for different LS-DAVF types. Furthermore, it confirms the necessity of achieving complete occlusion in symptomatic LS-DAVFs to effectively alleviate symptoms and improve patient outcomes.

METHODS

This study included 231 patients with LS-DAVFs who received continuous endovascular treatment at our hospital between 2001 and 2022. This article provides a detailed description of the patients' clinical presentation, angiographic features, treatment strategies, and both clinical and angiographic outcomes.

RESULTS

This study included 231 patients with LS-DAVFs who underwent endovascular treatment, including 149 patients who received transarterial embolization (TAE), 15 who underwent transvenous embolization (TVE), and 67 who were treated with a combination of TAE and TVE. According to the Borden classification, 90 patients had type I, 66 had type II, and 75 had type III DAVF. The mean age of the patients was 50.3 ± 12.9 years, with a total of 311 procedures performed. The most common arterial access routes were the middle meningeal artery and occipital artery. The complete occlusion rate was 76.2%, with 142 patients experiencing either complete resolution or improvement of their symptoms. The overall complication rate was 10.0%, comprising intracranial hemorrhage (5.6%), ischemic stroke (3.0%), and neurological deficits (1.3%).

CONCLUSION

TAE, or combined TVE (TAE + TVE), is a safe and effective treatment of LS-DAVFs. For patients with Borden type III DAVFs, complete occlusion of the fistula is essential to achieve a cure. In addition, for symptomatic LS-DAVFs, complete occlusion of the fistula plays a key role in the resolution of symptoms, significantly improving the patient's clinical condition.