Outcome of Therapies for Dural Arteriovenous Fistulas in Children

 

In general, if complete occlusion of the cranial DAVF can be achieved without complications, the vascular malformation can be cured with good clinical outcome. Occasionally downgrading these malformations from Borden grade II-III to Borden I can be accepted as a valid treatment. That being said, cranial DAVFs should be considered dynamic lesions that can recur and progress. Thus, long term follow-up is mandatory. Occasionally, spontaneous resolution of cranial DAVFs has been reported.

Outcome after endovascular surgery and surgery

  • Operative treatment outcomes: Endovascular therapy can cure these malformations in up to 70% of cases. In approximately 85% of cases the cortical venous drainage can be reversed(9). If endovascular treatment is not complete, surgery or radiosurgery can be used.

Outcome after non-surgical treatments

  • Non-operative treatment outcomes: The effects of radiosurgery are delayed (up to 36 months) and obliteration rates have been reported to be around 55%–80%, some of them with the use of combined endovascular treatment(21,26).

Outcome after multimodal therapies

  • Multi-modal treatment outcomes: With the use of multimodality treatment, rates of occlusion can be increased and morbidity/mortality can be decreased. Therefore, multispecialty team management is essential.