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Improved Turnaround Times | Median time to first decision: 12 days

Research ArticleNeurointervention
Open Access

Dural Arteriovenous Fistulas: Baseline Cognitive Changes and Changes following Treatment: A Prospective Longitudinal Study

Zeev Itsekson-Hayosh, Federico Carpani, Pascal J. Mosimann, Ronit Agid, Eef J. Hendriks, Ivan Radovanovic, Hugo Andrade Barazarte, Joanna D. Schaafsma, Karel Terbrugge, Timo Krings, Mary Pat McAndrews and Patrick Nicholson
American Journal of Neuroradiology December 2024, 45 (12) 1878-1884; DOI: https://doi.org/10.3174/ajnr.A8449
Zeev Itsekson-Hayosh
aFrom the Division of Neuroradiology (Z.I.-H., P.J.M., R.A., E.J.H., K.T., T.K., P.N.), University Medical Imaging and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Federico Carpani
bDepartment of Neurology, (F.C., J.D.S.), Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Pascal J. Mosimann
aFrom the Division of Neuroradiology (Z.I.-H., P.J.M., R.A., E.J.H., K.T., T.K., P.N.), University Medical Imaging and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
cDepartment of Neurosurgery (P.J.M., E.J.H., I.R., H.A.B., T.K), Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Ronit Agid
aFrom the Division of Neuroradiology (Z.I.-H., P.J.M., R.A., E.J.H., K.T., T.K., P.N.), University Medical Imaging and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Eef J. Hendriks
aFrom the Division of Neuroradiology (Z.I.-H., P.J.M., R.A., E.J.H., K.T., T.K., P.N.), University Medical Imaging and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
cDepartment of Neurosurgery (P.J.M., E.J.H., I.R., H.A.B., T.K), Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Ivan Radovanovic
cDepartment of Neurosurgery (P.J.M., E.J.H., I.R., H.A.B., T.K), Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Hugo Andrade Barazarte
cDepartment of Neurosurgery (P.J.M., E.J.H., I.R., H.A.B., T.K), Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Joanna D. Schaafsma
bDepartment of Neurology, (F.C., J.D.S.), Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Karel Terbrugge
aFrom the Division of Neuroradiology (Z.I.-H., P.J.M., R.A., E.J.H., K.T., T.K., P.N.), University Medical Imaging and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Timo Krings
aFrom the Division of Neuroradiology (Z.I.-H., P.J.M., R.A., E.J.H., K.T., T.K., P.N.), University Medical Imaging and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
cDepartment of Neurosurgery (P.J.M., E.J.H., I.R., H.A.B., T.K), Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Mary Pat McAndrews
dDepartment of Psychology (M.P.M.), University of Toronto, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Patrick Nicholson
aFrom the Division of Neuroradiology (Z.I.-H., P.J.M., R.A., E.J.H., K.T., T.K., P.N.), University Medical Imaging and Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
eDepartment of Neuroradiology (P.N.), Beaumont Hospital, Dublin, Ireland
fDepartment of Radiology (P.N.), Royal College of Surgeons of Ireland, Dublin, Ireland
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Abstract

BACKGROUND AND PURPOSE: Dural arteriovenous fistulas (DAVFs) exhibit varied clinical manifestations, and high-grade cases are associated with both a risk of hemorrhage and (in certain cases) dementia. Less known, however, is the association between DAVF and more subtle cognitive changes, which might not be clinically apparent without formal neurocognitive testing. This study prospectively assesses baseline cognitive changes in patients with unruptured DAVFs and looks at the effects of treatment on any such changes.

MATERIALS AND METHODS: A longitudinal prospective study was conducted to formally evaluate the neurocognitive status of patients with unruptured DAVFs undergoing embolization. Pre- and posttreatment assessments included neurologic examinations and cognitive tests (Repeatable Battery for the Assessment of Neuropsychological Status and Trail-Making Test [TMT]).

RESULTS: A total of 23 patients were treated, with 78% demonstrating cortical venous reflux at baseline. At baseline, 50% of patients demonstrated cognitive impairment in at least 1 cognitive domain, and this was significantly associated with cortical venous reflux (P < .05). Following treatment, significant improvements were observed in several cognitive domains. The mean change in Immediate Memory was an increase of 10.5 points (95% CI, 6.2–14.8, P < .001). Visuospatial/Constructional abilities showed a mean increase of 3.8 points (95% CI, 1.1–6.5, P = .008), while Language improved by a mean of 4.2 points (95% CI, 0.9–7.5, P = .015). Attention scores increased by a mean of 6.1 points (95% CI, 2.7–9.5, P < .001). Delayed Memory demonstrated a mean improvement of 7.4 points (95% CI, 3.5–11.3, P < .001), and the Total Repeatable Battery for the Assessment of Neuropsychological Status Score increased by a mean of 8.6 points (95% CI, 5.0–12.2, P < .001). For the TMT, the mean change in TMT-A was a decrease of 9.2 seconds (95% CI, 5.6–12.8, P < .001), indicating faster completion times. TMT-B scores decreased by a mean of 12.7 seconds (95% CI, 8.4–17.0, P < .001). The TMT B-A difference decreased by a mean of 3.5 seconds (95% CI, 0.5–6.5, P = .023), and the TMT B/A ratio showed a mean decrease of 0.18 (95% CI, 0.10–0.26, P = .002). Overall, among the patients with baseline cognitive impairment, 70% showed significant cognitive improvement following endovascular treatment, particularly in memory domains.

CONCLUSIONS: In our study, 50% of patients with DAVFs had cognitive impairment when assessed with formal neurocognitive testing, with a significant link to cortical venous reflux. This cognitive impairment improved in 70% of those patients following treatment. These findings expand our understanding of how DAVF affects the brain, highlighting cognitive impairment as a critical factor. Consequently, the treatment of DAVFs should perhaps not only focus on hemorrhagic risk but also consider cognitive outcomes as a potential indicator for intervention.

ABBREVIATIONS:

CVR
cortical venous reflux
DAVF
dural arteriovenous fistula
RBANS
Repeatable Battery for the Assessment of Neuropsychological Status
TMT
Trail-Making Test
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American Journal of Neuroradiology: 45 (12)
American Journal of Neuroradiology
Vol. 45, Issue 12
1 Dec 2024
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Cite this article
Zeev Itsekson-Hayosh, Federico Carpani, Pascal J. Mosimann, Ronit Agid, Eef J. Hendriks, Ivan Radovanovic, Hugo Andrade Barazarte, Joanna D. Schaafsma, Karel Terbrugge, Timo Krings, Mary Pat McAndrews, Patrick Nicholson
Dural Arteriovenous Fistulas: Baseline Cognitive Changes and Changes following Treatment: A Prospective Longitudinal Study
American Journal of Neuroradiology Dec 2024, 45 (12) 1878-1884; DOI: 10.3174/ajnr.A8449

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Cognitive Changes in Dural AV Fistula Treatment
Zeev Itsekson-Hayosh, Federico Carpani, Pascal J. Mosimann, Ronit Agid, Eef J. Hendriks, Ivan Radovanovic, Hugo Andrade Barazarte, Joanna D. Schaafsma, Karel Terbrugge, Timo Krings, Mary Pat McAndrews, Patrick Nicholson
American Journal of Neuroradiology Dec 2024, 45 (12) 1878-1884; DOI: 10.3174/ajnr.A8449
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