Two decades of cranial dural arteriovenous fistula care: individualized, multidisciplinary treatment selection and outcomes from a single center.

INTRODUCTION

Cranial dural arteriovenous fistulas (DAVF) are rare vascular malformations carrying significant intracranial hemorrhage risk, with symptoms ranging from benign to aggressive presentations. This study reports long-term outcomes of cranial DAVF patients treated over two decades using multidisciplinary approaches and explores the long-term clinical outcome and treatment efficacy of multidisciplinary management strategies.

MATERIALS AND

METHODS

This retrospective single-center study analyzed 61 cranial DAVF patients from 1998 to 2023. Demographics, clinical symptoms, fistula morphology, treatment modalities, and outcomes were evaluated. Treatment decisions involved multidisciplinary teams comprising neurosurgeons, neurologists, and neuroradiologists.

RESULTS

Among 61 patients, hemorrhage occurred in 49.2 %, with pulsatile tinnitus and seizures each representing 18.3 % of presentations. Borden classification revealed Type I (31 %), Type II (44.8 %), and Type III (24.1 %) fistulas, predominantly located at the transverse/sigmoid sinus (50 %). Borden classification did not significantly predict clinical outcomes (p = 0.692). Multidisciplinary treatment combined endovascular and surgical approaches in 28 % of cases, with endovascular-only and surgery-only strategies in 29.5 % and 26.2 %, respectively. Favorable clinical outcome occurred in 77 % of patients. Treatment complications occurred in 42.6 % (endovascular 28 %, surgical 15 %).

DISCUSSION AND

CONCLUSION

Multidisciplinary treatment strategies achieved high rates of favorable outcomes, emphasizing the importance of individualized case-by-case assessment.