Angioarchitecture and Endovascular Therapy of Infantile Dural Arteriovenous Fistulas.

Abstract

Infantile dural arteriovenous fistula (IDAVF) is a rare complex dural arteriovenous fistulas. This study is to provide a comprehensive understanding of the angioarchitecture of arteriovenous shunts in IDAVFs and planning endovascular treatment. Five cases of IDAVF and a literature review were analyzed to characterize the shunt patterns of IDAVFs in terms of anatomic relations to the arterial feeder, sinuses, and cortical veins. Treatment characteristics and outcomes were evaluated. A total of 37 cases of IDAVF were identified, including 32 cases from the 15 literature studies and five cases from our center. The patients' age is 11 weeks to 27 years, with an average of 6 ± 7.8 years. Fourteen patients were female, and 23 patients were male. IDAVFs were characterized by multiple high-flow fistulas fed by arterial feeders from six vessels converging to enlarged dural sinuses, most of which were torcular, transverse-sigmoid, or superior sagittal sinuses (94.6%). In 31 cases treated endovascularly, only 9 (29%) IDAVFs resulted in complete occlusion. Clinical outcomes were reported in 28 cases treated endovascularly with a 64.3% of morbidity (mRS ≥ 2) and mortality. There were no differences in complete occlusion rate (25% vs 33.3%, P > 0.999) and death rate (21.4% vs 21.4%, P > 0.999) between transarterial and transvenous approaches. IDAVFs were characterized by multiple high-flow fistulas fed by arterial feeders from six vessels converging to enlarged dural sinuses, most of which were torcular, transverse-sigmoid, or superior sagittal sinuses. Considering these multiple suppliers and high-flow shunts, transarterial or transvenous embolization is still insufficient and unsatisfactory.