483 Partial Treatment as a Risk Factor in Up-Conversion of Type 1 dAVFs. (April 2023)

• Record Type: Journal Article
• Authors: Walker, Erin; Srienc, Anja I.; Guniganti, Ridhima Rao; Brinjikji, Waleed; Chen, Ching-Jen; Abecassis, Isaac Josh; Levitt, Michael Robert; Durnford, Andrew; Polifka, Adam J.; Derdeyn, Colin P.; Samaniego, Edgar A.; Kwasnicki, Amanda M.; Alaraj, Ali; Potgieser, Adriaan R.E.; Sur, Samir; Tada, Yoshiteru; Winkler, Ethan A.; Lai, Rosalind; Du, Rose; Abla, Adib Adnan; Satomi, Junichiro; Starke, Robert M.; Van Dijk, Marc C.; Amin-Hanjani, Sepideh; Hayakawa, Minako; Gross, Bradley A.; Fox, William C.; Butlers, Diederik; Kim, Louis J.; Sheehan, Jason P.; Lanzino, Giuseppe; Osbun, Joshua William; Zipfel, Gregory J.;
• Is Part Of: Neurosurgery. Volume 69(2023)Supplement 1
• Page Start: 104
• Page End: 104
• Publication Date: 2023-04
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/neu.0000000000002375_483
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : INTRODUCTION: Type 1 dural arteriovenous fistulas (dAVFs) lack cortical venous drainage and occasionally necessitate intervention depending on patient symptoms. Up-conversion is the rare transformation of a dAVF to a higher-grade. Causes for up-conversion are unknown. We tested the hypothesis whether partial treatment of type 1 dAVFs increases their likelihood of up-conversion. METHODS: We used the multicenter Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database to perform a retrospective analysis of all patients with type 1 dAVFs. Propensity score analysis was utilized to determine if partial treatment was an independent risk factor for up-conversion. A regression model identified secondary risks that contributed to up-conversion. RESULTS: 358 out of 1077 patients within the consortium had type 1 dAVFs. 12% of patients who were partially treated for a type 1 dAVF experienced an up-conversion, while less than 1% of patients who received no treatment experienced up-conversion, and 0% of patients who had a complete treatment of their dAVF experienced up-conversion. Higher proportions of tinnitus, bruits, and intracranial hemorrhage at initial presentation were found in patients who up-converted. The majority of up-converted dAVFs were located in the transverse-sigmoid sinus and all received embolization as part of their treatment. CONCLUSIONS: Partial treatment is an independent risk factor for up-conversion when compared to no treatment or complete treatment. In the partial treatment group, hemorrhage at inital presentation and use of embolization as a treament modality are factors that increase risk for up-conversion.