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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 November 2024, 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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Article Figures & Data

Figures

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  • FIG 1.
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    FIG 1.

    The heat map shows individual patient cognitive performance pre- and posttreatment across various RBANS domains. Green shades indicate improvement, while red shades indicate declines. Darker colors represent more significant changes. The numeric values reflect deviations from average standardized scores, with positive values indicating above-average performance and negative values indicating below-average performance. These provide a visual representation for baseline values and outcomes for each patient pre- and posttreatment, as well as for the entire cohort.

  • FIG 2.
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    FIG 2.

    Diagnostic cerebral angiographies (left external carotid artery selective injections) showing a representative patient who presented with a low-grade DAVF (ie, no cortical venous reflux) and cognitive impairment, which improved following endovascular disconnection of the shunt. AP indicates anterior-posterior.

Tables

  • Figures
  • Cognitive performance of patients with DAVF, before and after endovascular embolization, stratified according to presence of CVRa

    Patients with CVRPatients without CVR
    Baseline (mean) (SD)% ImpairedPosttreatment(mean) (SD)% ImpairedReliable Change% above CutoffBaseline (mean) (SD)% ImpairedPosttreatment(mean) (SD)% ImpairedReliable Change% above Cutoff
    RBANS total87.795.586.8103.3
    14.9813.4614.8910.50
    28%23%24%20%0%25%
    RBANS Immediate Memory82.994.679.0103.5
    18.7215.0315.6011.79
    39%23%35%40%0%75%
    RBANS Delayed Memory87.395.886.0101.8
    22.4916.1424.4614.17
    33%18%24%20%0%0%
    RBANS Visuo spatial94.391.693.8100.8
    11.5818.0418.053.77
    22%41%0%40%0%0%
    RBANS Language91.198.295.8100.5
    9.6314.7513.9216.60
    22%6%12%20%25%0%
    RBANS Attention97.4102.597.6106.8
    21.2614.056.848.26
    28%6%18%0%0%25%
    TMT A (raw/z score)52.7/−1.550.6/−1.1NA52.4/−1.643.8/−1.2NA
    29.52/3.1628.75/2.1024.31/1.3814.75/1.83
    44%35%60%50%
    TMT B (raw/z score)164.2/−3.1157.5/−2.7NA132.2/−2.6146.8/−3.0NA
    113.89/4.39114.04/4.4395.93/2.09105.16/2.19
    50%53%60%75%
    TMT B-A (raw/z score)111.6/−2.6106.9/−2.5NA79.8/−1.8103.0/−2.4NA
    96.64/4.2395.58/4.4974.50/2.08111.41/3.12
    50%41%60%50%
    • Note:—NA indicates not applicable.

    • a RBANS data are presented as scaled scores, which have a mean of 100 (SD, 15). Higher scores indicate better cognitive performance. The RBANS assesses 5 cognitive domains: Immediate Memory, Visuospatial/Constructional Abilities, Language, Attention, and Delayed Memory. TMT A and B scores and their contrasts (B-A, B/a) are presented as raw scores in seconds, which measure the time taken to complete the test. Lower scores indicate faster performance and better cognitive function. These raw scores are also converted into z scores, which have a mean of 0 (SD, 1). Z scores allow comparison across different tests and populations, with higher z scores indicating better performance relative to the normative sample. Sample interpretation: RBANS Immediate Memory: a scaled score of 85 would indicate performance below the average (mean of 100) for the general population, suggesting some impairment in this cognitive domain. TMT: a raw score: 35 seconds would be converted to a z score for comparison. If this z score is −1.5, it indicates that the performance is 1.5 SDs below the mean, suggesting slower processing speed compared with the normative sample.

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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, Patrick Nicholson
American Journal of Neuroradiology Nov 2024, DOI: 10.3174/ajnr.A8449
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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 Nov 2024, DOI: 10.3174/ajnr.A8449

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