Endovascular Treatment for Tentorial Dural Arteriovenous Fistulas: A Retrospective Single-Center Study

BACKGROUND AND PURPOSE: Current evidence suggests that tentorial dural arteriovenous fistulas with endovascular treatment offer a high rate of occlusion and reduced procedural risks. Here we report the clinical and angiographic outcomes in patients with tentorial dural arteriovenous fistulas who underwent endovascular treatment as first-line treatment.

MATERIALS AND METHODS: A retrospective analysis was conducted on 83 patients with tentorial dural arteriovenous fistulas treated at our center from April 2009 to November 2023 using endovascular treatment. Patient demographics, clinical presentation, angiographic, treatment results, and follow-up outcomes were registered. Univariable and multivariable logistic regression were performed to identify onset of intracranial hemorrhage predictors, procedure-related complications predictors and predictors of poor functional outcome.

RESULTS: Eighty-three patients underwent endovascular treatment as first-line treatment. Most patients (80.7%) were symptomatic and a total of 25 patients (30.1%) presented with intracranial hemorrhage. Presence of deep venous drainage and midline location was associated with a lower incidence of intracranial hemorrhage. Middle meningeal artery (57.8%, 48/83) and pial artery (15.7%, 13/83) were the most frequently used access routes for embolization. A total of 74 (89.1%) TDAVFs were completely occluded after the last EVT session immediately. Complications occurred in 11 patients (13.3%). Six-month angiographic follow-up was performed in 68 patients (81.8%), and 91.2% (62/68) tentorial dural arteriovenous fistulas were occluded. At clinical follow-up (100%, 83/83), good functional outcome (mRS 0–2) was documented in 74 (89.1%) patients. Logistic regression analysis identified baseline mRS 3–5 as the most significant independent predictor of poor functional outcome. Subgroup analysis showed no statistically significant differences in baseline characteristics, angiographic and clinical results between patients treated with targeted pial artery embolization and non-targeted pial artery embolization.

CONCLUSIONS: Endovascular treatment is a safe and effective primary modality for managing tentorial dural arteriovenous fistulas, achieving high rates of complete angiographic occlusion and favorable functional outcomes. Transarterial embolization, predominantly via middle meningeal artery, was the mainstay of treatment. In patients with pial arterial feeders, omitting aggressive embolization did not compromise efficacy or increase complications.

ABBREVIATIONS: DAVF = dural arteriovenous fistula; TDAVF = tentorial dural arteriovenous fistula; EVT = endovascular treatment; TAE = transarterial embolization; TVE = transvenous embolization; MMA = middle meningeal artery