Bridging the gap: A scoping review of endovascular and microsurgical approaches to anterior ethmoidal dural arteriovenous fistulas.

Abstract

Introduction: Dural arteriovenous fistulas (dAVF) are abnormal anastomoses between meningeal arteries and dural venous sinuses. Typically, dAVF treatment involves an endovascular or microsurgical approach. Anterior ethmoidal artery (AEA) dAVFs pose unique challenges due to their anatomy and location. We performed a scoping review to characterize pre and postoperative characteristics of AEA dAVFs and elucidate their optimal management.

Methods: The authors conducted a comprehensive literature search on PubMed and Embase using Arskey & O'Malley's scoping review framework. The search strategy included "anterior," "ethmoidal," and "fistula" and excluded review articles and studies with unrelated pathology. Data collected included patient demographics, presentation, angiographic features, treatment modalities, and clinical and radiological outcomes.

Results: One-hundred and two articles describing 273 patients with an average age of 58.79 years were included. Two-hundred and sixty patients had surgery; 127 (49 %) had endovascular embolization and 133 (51 %) had open surgery. Surgical approach was significantly associated with complete dAVF obliteration (p = 0.003, X²=8.73, N = 206); patients treated endovascularly were less likely to have complete dAVF obliteration (85.9 % for endovascular versus 97.2 % for microsurgery). Additionally, patients with preoperative dAVF rupture had significantly greater rates of postoperative hemorrhage (p = 0.003, X²=11.86, N = 184).

Discussion: Surgical techniques and endovascular embolization are commonly used when treating dAVF, and our results highlight that open surgery appears to be superior to endovascular embolization when considering complete AEA dAVF obliteration. Despite advancements in treatment modalities, complications such as stroke, hemorrhage, and recurrence persist, emphasizing the importance of continued research and refinement of therapeutic strategies.