Intracranial dural arteriovenous fistulas with deep venous drainage: a single-center retrospective cohort study

Objective: Dural arteriovenous fistulas (DAVFs) with deep venous drainage (DVD) (DAVFs-DVD) are characteristically associated with non-hemorrhagic neurological deficits, most notably cognitive impairment. Large studies have yet to thoroughly characterize these DAVFs. We conducted an analysis of the largest cohort of DAVFs-DVD to provide a comprehensive characterization of this specific subset. Methods: This study was a retrospective cohort analysis of 207 patients with DAVFs-DVD who were hospitalized at a single medical center between 2001 and 2022. Logistic regression was employed to identify angiographic features specific to DAVFs associated with cognitive impairment. Additionally, post-treatment outcomes were evaluated. Results: DAVFs-DVDs can be classified into two categories: the Galenic group, where arterial feeders drain directly into the vein of Galen (VoG), and the non-Galenic group, where arterial feeders drain into other veins or venous sinuses and indirectly flow into the VoG. Cognitive impairment accounting for 15.9% of all clinical presentations. We found that the overall rate of complete occlusion was 86.6%, while the overall rate of complications was 16.4%. Moreover, patients with DAVFs-DVD presenting with cognitive impairment were more likely to have straight sinus stenosis or occlusion, as well as DAVFs located at the midline. Conclusion: DAVFs-DVDs can be classified into two categories: the Galenic group and the non-Galenic group. Patients with DAVFs-DVD presenting with cognitive impairment were more likely to have straight sinus stenosis or occlusion, as well as DAVFs located at the midline. Venous hypertension of the deep venous system is a key angiographic feature of DAVFs associated with thalamic cognitive impairment.