Morphological, clinical, and procedural determinants of embolization outcomes in non-cavernous cerebral dural arteriovenous fistulas: A retrospective study
5 affiliations
- 1Department of Interventional Neuroradiology, University Hospital Ghent, Belgium; Corresponding author at: Department of Interventional Neuroradiology, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
- 2Department of Interventional Neuroradiology, University Hospital Ghent, Belgium
- 3Department of Interventional Neuroradiology, University Hospital Ghent, Belgium; Department of Maxillofacial Surgery, Sint Blasius Hospital Dendermonde, Belgium
- 4Department of Neurosurgery, University Hospital Ghent, Belgium
- 5Department of Neurology, University Hospital Ghent, Belgium
Abstract
Purpose: The purpose of this retrospective study was to determine whether dAVF (dural arteriovenous fistula) characteristics influences treatment indication, embolization techniques, complications, radiation burden, and outcome. Methods and Materials: Patients treated by embolization for a brain dAVF were included. Excluded were cavernous sinus and surgically treated dAVF. Patients’ demographics, clinical and treatment data were retrieved. dAVF clusters were formed: haemorrhagic versus non-haemorrhagic onset and sinus versus non-sinus type and impact on treatment indication, complications, radiation burden, functional and angiographic outcome was analyzed. Results: In a study involving 119 dAVF in 115 patients, 33 patients (mean age 62 years ± 1.8, 72.7% males) presented with a haemorrhagic onset, while 82 (mean age 58 years ± 1.6, 57.3% females) exhibiting 86 dAVF had no bleeding. The sigmoid sinus was over-represented in the latter (52.3%), whereas a cerebrocortical occipital vein was frequently involved in the former group (27,3%). All but one haemorrhagic dAVF demonstrated a Borden-III classification. At six months, the prevalence of mRS class “0” was significantly higher in the non-haemorrhagic dAVF group (70.7% versus 32.3%) compared to the sinus-type clusters, where no such difference was observed. Six months angiography revealed occlusion in 88.2% of 102 catheterized fistulae, similar for all groups. Onyx volume and injection time was significantly higher in non-haemorrhagic and sinus-type dAVF. In non-haemorrhagic dAVF, fluoroscopy time (66.16 versus 40.48 minutes) and the number of acquisitions (68 versus 50) was significantly higher, but not radiation exposure. Although rare, mortality occurred only in sinus-type non-haemorrhagic dAVF. Facial nerve palsy was the major adverse event in non-haemorrhagic dAVF. Conclusion: Employing comparable techniques, occluding non-haemorrhagic onset dAVF takes longer and requires a larger embolic volume, yet it presents a higher likelihood of achieving an excellent functional outcome. Occlusion rates are high in all dAVF clusters. Managing non-haemorrhagic, sinus-type dAVFs requires careful attention.
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BibTeX
@article{lucdefreyne2026morphological,
title = {{Morphological, clinical, and procedural determinants of embolization outcomes in non-cavernous cerebral dural arteriovenous fistulas: A retrospective study}},
author = {Luc Defreyne, MD, PhD and Lynn Huyck, MS, PhD and Peter Vanlangenhove, MD, PhD1 and Wouter De Coninck, MD and Edward Baert, MD PhD and Dimitri Hemelsoet, MD and Elisabeth Dhondt, MD, PhD},
journal = {Journal of Stroke and Cerebrovascular Diseases},
year = {2026},
month = oct,
doi = {10.1016/j.jstrokecerebrovasdis.2026.108763},
url = {https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108763},
note = {CC BY},
}
RIS
TY - JOUR
TI - Morphological, clinical, and procedural determinants of embolization outcomes in non-cavernous cerebral dural arteriovenous fistulas: A retrospective study
AU - Luc Defreyne, MD, PhD
AU - Lynn Huyck, MS, PhD
AU - Peter Vanlangenhove, MD, PhD1
AU - Wouter De Coninck, MD
AU - Edward Baert, MD PhD
AU - Dimitri Hemelsoet, MD
AU - Elisabeth Dhondt, MD, PhD
PY - 2026
DA - 2026/10/30
JO - Journal of Stroke and Cerebrovascular Diseases
DO - 10.1016/j.jstrokecerebrovasdis.2026.108763
UR - https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108763
AB - Purpose: The purpose of this retrospective study was to determine whether dAVF (dural arteriovenous fistula) characteristics influences treatment indication, embolization techniques, complications, radiation burden, and outcome. Methods and Materials: Patients treated by embolization for a brain dAVF were included. Excluded were cavernous sinus and surgically treated dAVF. Patients’ demographics, clinical and treatment data were retrieved. dAVF clusters were formed: haemorrhagic versus non-haemorrhagic onset and sinus versus non-sinus type and impact on treatment indication, complications, radiation burden, functional and angiographic outcome was analyzed. Results: In a study involving 119 dAVF in 115 patients, 33 patients (mean age 62 years ± 1.8, 72.7% males) presented with a haemorrhagic onset, while 82 (mean age 58 years ± 1.6, 57.3% females) exhibiting 86 dAVF had no bleeding. The sigmoid sinus was over-represented in the latter (52.3%), whereas a cerebrocortical occipital vein was frequently involved in the former group (27,3%). All but one haemorrhagic dAVF demonstrated a Borden-III classification. At six months, the prevalence of mRS class “0” was significantly higher in the non-haemorrhagic dAVF group (70.7% versus 32.3%) compared to the sinus-type clusters, where no such difference was observed. Six months angiography revealed occlusion in 88.2% of 102 catheterized fistulae, similar for all groups. Onyx volume and injection time was significantly higher in non-haemorrhagic and sinus-type dAVF. In non-haemorrhagic dAVF, fluoroscopy time (66.16 versus 40.48 minutes) and the number of acquisitions (68 versus 50) was significantly higher, but not radiation exposure. Although rare, mortality occurred only in sinus-type non-haemorrhagic dAVF. Facial nerve palsy was the major adverse event in non-haemorrhagic dAVF. Conclusion: Employing comparable techniques, occluding non-haemorrhagic onset dAVF takes longer and requires a larger embolic volume, yet it presents a higher likelihood of achieving an excellent functional outcome. Occlusion rates are high in all dAVF clusters. Managing non-haemorrhagic, sinus-type dAVFs requires careful attention.
SN - 1532-8511
ER -