Dural Arteriovenous Fistulas at the Craniocervical Junction: A Systematic Review and Meta-Analysis Publisher Pubmed



Qedair J^{1, 2} ; Sankarappan K³ ; Mirahmadi Eraghi M^{5, 6} ; Gersey ZC⁷ ; Agarwal P⁷ ; Anand SK⁷ ; Palmisciano P⁸ ; Blackwell M⁹ ; Maroufi SF¹⁰ ; Aoun SG¹¹ ; El Ahmadieh TY¹² ; Cohengadol AA¹³ ; Binalamer O¹² Show Affiliations
Source: Neurosurgical Review Published:2024

Abstract

Background: The management for craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) remains controversial and clinically challenging. We systemically summarized the clinical and angiographic outcomes of microsurgery, embolization, and conservative management. Methods: Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane, following PRISMA guidelines. A systematic review and meta-analysis were conducted on the clinical characteristics, management approaches, and clinical and angiographic outcomes. Results: We included 13 articles (166 patients). The weighted mean age was 58.9 years (95%CI: 53.2–64.5), 58.8 years (95%CI: 48.4–69.2), and 63.8 years (95%CI: 60.1–67.5), in microsurgery, embolization, and conservative groups respectively, with an overall male sex predominance (microsurgery [n = 51/77, 66.2%], embolization [n = 44/56, 78.6%], and conservative management [n = 6/8, 75.0%]). Patients were managed with microsurgery (n = 80/172, 46.5%), embolization (n = 79/172, 45.9%), and conservative treatment (n = 13/172, 7.6%). Foramen magnum was the most common location (microsurgery [n = 34/77, 44.2%], embolization [n = 31/56, 55.4%], and conservative treatment [n = 3/8, 37.5%]). Vertebral artery was the primary feeder (microsurgery [n = 58/84, 69.1%], embolization [n = 41/86, 47.6%], and conservative treatment [n = 4/7, 57.1%]). Complete fistula obliteration rates were 74.1% (95%CI:52.3–88.2%) in the microsurgery group and 54.9% (95%CI:30.7–77.0%) in the embolization group. Complications rates were 16.2% (95%CI:6.7–34.5%) in the embolization group, 11.6% (95%CI:3.8–30.4%) in the microsurgery group, and 7.7% (95%CI:1.1–39.1%) in the conservative group. Different rates of good clinical outcomes were observed [microsurgery: 66.4% (95%CI:48.1–80.8%), embolization: 51.9% (95%CI:30.8–72.4%), and conservative: 11.6% (95%CI:4.4–27.4%)]. Conclusions: In patients with CCJ-DAVFs, each management approach has its own merits based on the fistula and patient characteristics. © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024.