• Isaac Josh Abecassis, MeyerR MichaelRMDepartments of1Neurological Surgery., Michael R Levitt, Jason P Sheehan, Ching-Jen Chen, Bradley A Gross, Jessica Smith, W Christopher Fox, Enrico Giordan, Giuseppe Lanzino, Robert M Starke, Samir Sur, Adriaan R E Potgieser, van DijkJ Marc CJMC11Department of Neurosurgery, University of Groningen, University Medical Center Groningen, The Netherlands., Andrew Durnford, Diederik Bulters, Junichiro Satomi, Yoshiteru Tada, Amanda Kwasnicki, Sepideh Amin-Hanjani, Ali Alaraj, Edgar A Samaniego, Minako Hayakawa, Colin P Derdeyn, Ethan Winkler, Adib Abla, LaiPui Man RosalindPMR17Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and., Rose Du, Ridhima Guniganti, Akash P Kansagra, Gregory J Zipfel, Louis J Kim, Consortium for Dural Arteriovenous Fistula Outcomes Research, and CONDOR Collaborators .
• Departments of1Neurological Surgery.
• J. Neurosurg. 2022 Apr 1; 136 (4): 981989981-989.

ObjectiveCranial dural arteriovenous fistulas (dAVFs) are often treated with endovascular therapy, but occasionally a multimodality approach including surgery and/or radiosurgery is utilized. Recurrence after an initial angiographic cure has been reported, with estimated rates ranging from 2% to 14.3%, but few risk factors have been identified. The objective of this study was to identify risk factors associated with recurrence of dAVF after putative cure.MethodsThe Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) data were retrospectively reviewed. All patients with angiographic cure after treatment and subsequent angiographic follow-up were included. The primary outcome was recurrence, with risk factor analysis. Secondary outcomes included clinical outcomes, morbidity, and mortality associated with recurrence. Risk factor analysis was performed comparing the group of patients who experienced recurrence with those with durable cure (regardless of multiple recurrences). Time-to-event analysis was performed using all collective recurrence events (multiple per patients in some cases).ResultsOf the 1077 patients included in the primary CONDOR data set, 457 met inclusion criteria. A total of 32 patients (7%) experienced 34 events of recurrence at a mean of 368.7 days (median 192 days). The recurrence rate was 4.5% overall. Kaplan-Meier analysis predicted long-term recurrence rates approaching 11% at 3 years. Grade III dAVFs treated with endovascular therapy were statistically significantly more likely to experience recurrence than those treated surgically (13.3% vs 0%, p = 0.0001). Tentorial location, cortical venous drainage, and deep cerebral venous drainage were all risk factors for recurrence. Endovascular intervention and radiosurgery were associated with recurrence. Six recurrences were symptomatic, including 2 with hemorrhage, 3 with nonhemorrhagic neurological deficit, and 1 with progressive flow-related symptoms (decreased vision).ConclusionsRecurrence of dAVFs after putative cure can occur after endovascular treatment. Risk factors include tentorial location, cortical venous drainage, and deep cerebral drainage. Multimodality therapy can be used to achieve cure after recurrence. A delayed long-term angiographic evaluation (at least 1 year from cure) may be warranted, especially in cases with risk factors for recurrence.

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