Background and Purpose: Intracranial dural arteriovenous fistulas (DAVFs) are abnormal shunts between dural arteries and dural venous sinus or cortical veins. We report our experience with endovascular therapy of primary complex DAVFs using modern embolic agents. Methods: This is a retrospective analysis of patients with DAVFs treated between 2015 and 2019. Patient demographics and technical aspects including the use of embolic agent, access to the fistula, number of treatments, occlusion rates, and complications were addressed. Angiographic treatment success was defined as complete occlusion (CO) of the DAVF. Results: Fifty patients were treated endovascularly. Median age was 61 years and 66% were men. The most common symptom was pulsatile tinnitus in 17 patients (34%). The most frequent location of the DAVF was the transverse-sigmoid sinus (40%). Thirty-six fistulas (72%) had cortical venous reflux. Nonadhesive and adhesive liquid agents were used in 92% as a single material or in combination. CO was achieved in 48 patients (96%). In 28 individuals (56%), only 1 procedure was necessary. Nonadhesive liquid agents were exclusively used in 14 patients (28%) with CO attained in every case. For CO of tentorial DAVFs, multiple sessions were more often required than at the other locations (55 vs. 14%, p = 0.0051). Among 93 procedures, the overall complication rate was 3%. The procedure-related mortality rate was 0%. Conclusion: Endovascular treatment of intracranial DAVFs is feasible, safe, and effective with high rates of CO. In more than half of the patients, the DAVF was completely occluded after a single procedure. However, in tentorial DAVFs, multiple sessions were more often required.
Cerebrovasc Dis Extra 2020;10:84–93

中文翻译：

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颅内硬脑膜动静脉瘘的血管内治疗：德国单中心经验。

背景与目的：颅内硬脑膜动静脉瘘（DAVF）是硬脑膜动脉与硬脑膜静脉窦或皮质静脉之间的异常分流。我们报告了使用现代栓塞剂进行原发性复杂DAVF的血管内治疗的经验。方法：这是对2015年至2019年间接受治疗的DAVF患者的回顾性分析。研究了患者的人口统计学和技术方面，包括栓塞剂的使用，瘘管的进入，治疗次数，闭塞率和并发症。血管造影治疗成功定义为DAVF完全闭塞（CO）。结果：五十名患者接受了血管内治疗。中位年龄为61岁，男性为66％。最常见的症状是17例患者（34％）的搏动性耳鸣。DAVF的最常见位置是横贯乙状窦（40％）。三十六例瘘管（72％）有皮质静脉回流。非粘合剂和粘合剂液体试剂以92％的单一材料或组合形式使用。48例患者（96％）达到了CO。在28个人（56％）中，仅需要进行1次手术。在每种情况下，仅14例患者（28％）使用了非黏性液体制剂。对于幕后DAVF的CO，与其他位置相比，经常需要进行多次会话（55 vs. 14％，p = 0.0051）。在93例手术中，总并发症发生率为3％。手术相关死亡率为0％。结论：颅内DAVF的血管内治疗是可行，安全且有效的，且CO发生率高。在一半以上的患者中，单一手术后DAVF被完全闭塞。但是，在期限性DAVF中，更经常需要多个会话。
Cerebrovasc Dis Extra 2020; 10：84–93