Abstract
PurposeThis study aims to determine local diagnostic reference levels (DRLs) in the endovascular therapy (EVT) of patients with cranial and spinal dural arteriovenous fistula (dAVF).MethodsIn a retrospective study design, DRLs and achievable dose (AD) were assessed for all patients with cranial and spinal dAVF undergoing EVT (I) or diagnostic angiography (II). All procedures were performed at the flat-panel angiography-system Allura Xper (Philips Healthcare). Interventional procedures were differentiated according to the region of fistula and the type of procedure.ResultsIn total, 264 neurointerventional procedures of 131 patients with dAVF (94 cranial, 37 spinal) were executed between 02/2010 and 12/2020. The following DRLs, AD, and mean values could be determined: for cranial dAVF (I) DRL 507.33 Gy cm2, AD 369.79 Gy cm2, mean 396.51 Gy cm2; (II) DRL 256.65 Gy cm2, AD 214.19 Gy cm2, mean 211.80 Gy cm2; for spinal dAVF (I) DRL 482.72 Gy cm2, AD 275.98 Gy cm2, mean 347.12 Gy cm2; (II) DRL 396.39 Gy cm2, AD 210.57 Gy cm2, mean 299.55 Gy cm2. Dose levels of EVT were significantly higher compared to diagnostic angiographies (p < 0.001). No statistical difference in dose levels regarding the localization of dAVF was found.ConclusionOur results could be used for establishing DRLs in the EVT of cranial and spinal dAVF. Because radiation exposure to comparably complex interventions such as AVM embolization is similar, it may be useful to determine general DRLs for both entities together.
Highlights
MethodsCranial dural arteriovenous fistulas represent 10–15% of all intracranial vascular malformations with arteriovenous shunting and belong to the most frequently acquired vascular lesions of the central nervous system [1, 2]
Endovascular therapy (EVT) of patients with cranial dural arteriovenous fistula (dAVF) evolved as the first-line treatment with high occlusion rates, low risk profile, and very low recurrence rates [7,8,9]
The gender distribution in both cohorts was in favor of the male gender
Summary
MethodsCranial dural arteriovenous fistulas (dAVFs) represent 10–15% of all intracranial vascular malformations with arteriovenous shunting and belong to the most frequently acquired vascular lesions of the central nervous system [1, 2]. The indication for treatment depends on the morphology of the cranial dAVF, the resulting probability of bleeding, and clinical presentation. High-grade fistulas type 2b-5 with cortical reflux classified by Cognard/Merland have a significantly higher risk of intracranial hemorrhage [3, 4]. In low-grade fistulas, type 1-2a by Cognard/Merland, a therapy refractory pulse-synchronous tinnitus is a typical treatment indication [5, 6]. Endovascular therapy (EVT) of patients with cranial dAVF evolved as the first-line treatment with high occlusion rates, low risk profile, and very low recurrence rates [7,8,9]. Microsurgery, stereotactic radiosurgery, or combined therapy approaches remain as alternative treatment options
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