Management and Outcome of Intracranial Dural Arteriovenous Fistulas That Have Caused a Hemorrhage in the Posterior Fossa : A Clinical Study.

Abstract

We evaluated the diagnosis, treatment, and long-term results of patients with dural arteriovenous fistula (dAVF), which is a very rare cause of posterior fossa hemorrhage. This study included 15 patients who underwent endovascular, surgical, combined, or Gamma Knife treatments between 2012 and 2020. Demographics and clinical features, angiographic features, treatment modalities, and outcomes were analyzed. The mean age of the patients was 40 ± 17 (range 17-68), and 68% were men (11/15). Seven of the patients (46.6%) were in the age group of 50 years and older. While the mean Glasgow Coma Scale was 11.5 ± 3.9 (range 4-15), 46.3% presented with headache, and 53.7% had stupor/coma. Four (26.6%) patients had only cerebellar hematoma and headache. All dAVFs had cortical venous drainage. In 11 (73.3%) patients, the fistula was located in the tentorium and was the most common localization. Three (20%) patients had transverse and sigmoid sinus localizations, while one (6.7%) patient had dAVF located in the foramen magnum. Eighteen sessions were performed on the patients during endovascular treatment. Sixteen (88.8%) sessions were performed with the transarterial (TA) route, one (5.5%) session with the transvenous (TV) route, and one (5.5%) session with the TA + TV route. Surgery was performed in two (14.2%) patients. One (7.1%) patient passed away. While there were nine (64.2%) patients with a Rankin score between 0 and 2, the total closure rate was 69.2% in the first year of control angiograms. In the differential diagnosis of posterior fossa hemorrhages, the differential diagnosis of dAVFs, which is a very rare entity, should be considered, even in the middle and elderly age groups, in patients presenting with good clinical status and pure hematoma. The treatment of such patients can be done safely and effectively in a multidisciplinary manner with a good understanding of pathological vascular anatomy and appropriate endovascular treatment approaches.