Endovascular therapy of intracranial dural fistulae - Experience with 47 cases

Purpose: To report our experience with endovascular therapy of intracranial dural arteriovenous fistulae (IDFs), Methods: The location, etiology, clinical features, and utility of endovascular therapy in 47 cases of intracranial dural fistulae were retrospectively reviewed. Results: The clinical presentation and the success of treatment in patients with IDFs depended predominantly on the type of venous drainage. The severity of the clinical symptoms was related to the degree of vascular supply arising fr om the external carotid artery (ECA), particularly in those IDFs draining into a transverse sinus. IDFs in the tentorium were the most complex anatomically and the most technically challenging to treat. The effectiveness of later radiosurgery was directly related to the number of afferent arteries remaining after endovascular embolization, Conclusion: The location, degree of vascular supply, and venous drainage of the fistulae were the most important factors that determined the success of endovascular therapy and radiosurgery. In patients with IDFs, the treatment of choice is endovascular therapy alone or in combination with radiosurgery, as shown by the resolution of most fistulae in this series. In patients with dural fistulae of the cavernous sinus, the appropriate therapy is to occlude the parent sinus da the transvenous approach. In each case the therapeutic goal is complete obliteration of the fistula.