• Sebastian Sanchez, Linder Wendt, Minako Hayakawa, Ching-Jen Chen, Jason P Sheehan, Louis J Kim, Isaac Josh Abecassis, Michael R Levitt, MeyerR MichaelRMDepartment of Neurosurgery, University of Washington, Seattle, Washington, USA., Ridhima Guniganti, Akash P Kansagra, Giuseppe Lanzino, Enrico Giordan, Waleed Brinjikji, Diederik O Bulters, Andrew Durnford, W Christopher Fox, Jessica Smith, Adam J Polifka, Bradley Gross, Sepideh Amin-Hanjani, Ali Alaraj, Amanda Kwasnicki, Robert M Starke, Stephanie H Chen, van DijkJ Marc CJMCDepartment of Neurosurgery, University of Groningen, Groningen, Netherlands., Adriaan R E Potgieser, Junichiro Satomi, Yoshiteru Tada, Ryan Phelps, Adib Abla, Ethan Winkler, Rose Du, Pui Man Rosalind Lai, Santiago Ortega-Gutierrez, Gregory J Zipfel, Colin Derdeyn, and Edgar A Samaniego.
• Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
• Neurosurgery. 2023 Dec 14.

Background And ObjectivesAnecdotal cases of rapidly progressing dementia in patients with dural arteriovenous fistulas (dAVFs) have been reported in small series. However, large series have not characterized these dAVFs. We conducted an analysis of the largest cohort of dAVFs presenting with cognitive impairment (dAVFs-CI), aiming to provide a detailed characterization of this subset of dAVFs.MethodsPatients with dAVFs-CI were analyzed from the CONDOR Consortium, a multicenter repository comprising 1077 dAVFs. A propensity score matching analysis was conducted to compare dAVFs-CI with Borden type II and type III dAVFs without cognitive impairment (controls). Logistic regression was used to identify angiographic characteristics specific to dAVFs-CI. Furthermore, post-treatment outcomes were analyzed.ResultsA total of 60 patients with dAVFs-CI and 60 control dAVFs were included. Outflow obstruction leading to venous hypertension was observed in all dAVFs-CI. Sinus stenosis was significantly associated with dAVFs-CI (OR 2.85, 95% CI: 1.16-7.55, P = .027). dAVFs-CI were more likely to have a higher number of arterial feeders (OR 1.56, 95% CI 1.22-2.05, P < .001) and draining veins (OR 2.05, 95% CI 1.05-4.46, P = .004). Venous ectasia increased the risk of dAVFs-CI (OR 2.38, 95% CI 1.13-5.11, P = .024). A trend toward achieving asymptomatic status at follow-up was observed in patients with successful closure of dAVFs (OR 2.86, 95% CI 0.85-9.56, P = .09).ConclusionVenous hypertension is a key angiographic feature of dAVFs-CI. Moreover, these fistulas present at a mean age of 58 years-old, and exhibit a complex angioarchitecture characterized by an increased number of arteriovenous connections and stenosed sinuses. The presence of venous ectasia further exacerbates the impaired drainage and contributes to the development of dAVFs-CI. Notably, in certain cases, closure of the dAVF has the potential to reverse symptoms.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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