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Spontaneous closure of non-cavernous sinus dural arteriovenous fistulas: A case series and systematic review of the literature - 14/09/20

Doi : 10.1016/j.neurad.2020.09.002 
Nobuo Kashiwagi a, , Koichi Miyazaki b , Hiroto Takahashi c , Kiyoshi Tsuji d , Masahiro Fujiwara e , Atsuko Arisawa e , Hajime Nakamura f , Haruhiko Kishima f , Kazunari Ishii b , Noriyuki Tomiyama e
a Department of Future Diagnostic Radiology, Osaka University Graduate School of Medicine, Japan 
b Department of Radiology, Kindai University Faculty of Medicine, Japan 
c Center for twin research, Osaka University Graduate School of Medicine, Japan 
d Department of Neurosurgery, Kindai University Faculty of Medicine, Japan 
e Department of Radiology, Osaka University Graduate School of Medicine, Japan 
f Department of Neurosurgery, Osaka University Graduate School of Medicine, Japan 

Corresponding author.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 14 September 2020

Graphical abstract

Both high- and low-risk cranial dural arteriovenous fistulas (DAVFs) can close spontaneously. Our institutional review found that 9 of 68 patients with non-cavernous sinus DAVFs showed spontaneous closure. An analysis combining data from our patients and those identified in a systematic literature review indicated that 36% of spontaneous closures occurred within 3 months from the initial diagnosis and the most frequent predisposing factor was angiography.

Le texte complet de cet article est disponible en PDF.

Highlights

Cranial dural arteriovenous fistulas can close spontaneously.
The peak period for shunt closures is within 3 months from the initial diagnosis.
The most frequent predisposing factor for shunt closures was arteriography.
Predisposing factors for shunt closures were not identified in 70% of cases.

Le texte complet de cet article est disponible en PDF.

Abstract

Background and purpose

To report 9 new cases of non-cavernous sinus dural arteriovenous fistulas (NCS-DAVFs) that closed spontaneously and systematically review reports of other cases in the literature.

Material and methods

We performed a retrospective analysis of 9 cases from 2 institutions of NCS-DAVFs that closed spontaneously. Using PubMed and Scopus in accordance with the PRISMA guidelines, we systematically reviewed English language articles about NCS-DAVFs showing spontaneous closure.

Results

Review of the cases from 2 institutions identified 9 cases of NCS-DAVFs showing spontaneous closure in follow-up magnetic resonance angiography (MRA), and the systematic review of the literature yielded an additional 38 cases, which had been diagnosed by repeated arteriography. Collectively, the patients included 23 men and 24 women with a mean age of 54 years. The shunts were located in the transverse-sigmoid sinus in 24 cases (51%), anterior condylar confluence in 11, and other locations in 12. Based on the venous drainage pattern on arteriography, 27 cases (57%) were classified as low-risk NCS-DAVF (without cortical venous reflux) and 17 were classified as high-risk NCS-DAVF (with cortical venous reflux). Shunt closure was observed within 3 months in 17 cases (36%). Extrinsic predisposing factors for shunt closure were detected in 14 cases (30%). These included angiography in 7 cases, sinus recanalization in 4, development of sinus occlusion in 2, and sinus compression by a newly developed hematoma in 1.

Conclusion

Spontaneous closures of NCS-DAVFs can occur for both high- and low-risk types. One-third of these closures occur within 3 months.

Le texte complet de cet article est disponible en PDF.

Keywords : Dural arteriovenous fistula, Spontaneous closure, Magnetic resonance angiography, Arteriography


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