Abstract
PurposeAlthough intracranial dural arteriovenous fistula (DAVF) without retrograde leptomeningeal venous drainage (Borden type I) is reported to have a benign nature, no study has prospectively determined its clinical course. Here, we report a 3-year prospective observational study of Borden type I DAVF.MethodsFrom April 2013 to March 2016, consecutive patients with DAVF were screened at 13 study institutions. We collected data on baseline characteristics, clinical symptoms, angiography, and neuroimaging. Patients with Borden type I DAVF received conservative care while palliative intervention was considered when the neurological symptoms were intolerable, and were followed at 6, 12, 24, and 36 months after inclusion.ResultsDuring the study period, 110 patients with intracranial DAVF were screened and 28 patients with Borden type I DAVF were prospectively followed. None of the patients had conversion to higher type of Borden classification or intracranial hemorrhage during follow-up. Five patients showed spontaneous improvement or disappearance of neurological symptoms (5/28, 17.9%), and 5 patients showed a spontaneous decrease or disappearance of shunt flow on imaging during follow-up (5/28, 17.9%). Stenosis or occlusion of the draining sinuses on initial angiography was significantly associated with shunt flow reduction during follow-up (80.0% vs 21.7%, p = 0.02).ConclusionIn this 3-year prospective study, patients with Borden type I DAVF showed benign clinical course; none of these patients experienced conversion to higher type of Borden classification or intracranial hemorrhage. The restrictive changes of the draining sinuses at initial diagnosis might be an imaging biomarker for future shunt flow reduction.
Highlights
Several studies have explored the natural history of intracranial dural arteriovenous fistula (DAVF) without retrograde leptomeningeal venous drainage (RLVD), classified
110 patients with intracranial DAVF were screened, with 40 patients classified as Borden without RLVD, 27 patients classified as Borden type II, and 43 patients classified as Borden type III
Gross et al reported the natural history of 126 untreated patients with Borden type I DAVF and found that spontaneous obliteration occurred in 3% of the cases [4]
Summary
Several studies have explored the natural history of intracranial dural arteriovenous fistula (DAVF) without retrograde leptomeningeal venous drainage (RLVD), classified. Neuroradiology as Borden type I [1,2,3,4,5]. Most of these previous reports had indicated that the natural history of DAVF without RLVD is a benign type. Spontaneous occlusion of the disease has been shown to occur in 3–13% of patients. The results of Borden type I DAVF noted above were based on retrospective case series with various observation periods, which limits the reliability of the results. The more detailed time-dependent change in the disease will not become clear without prospective observation with scheduled follow-up
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