Outcome of Therapies for Dural Arteriovenous Fistulas in Children

Cranial DAVFs, in general, can be cured with good clinical outcomes in cases of complete occlusion of the malformation without complications. However, cranial DAVFs should be considered dynamic entities that can recur and progress. Long-term follow-up of these lesions is mandatory.

Outcome After Surgery

The majority of DAVFs are now treated endovascularly (6). If first-line endovascular obliteration is incomplete, open cranial surgery or radiosurgery can be employed.

Endovascular Surgery

• Endovascular treatment outcomes: Endovascular therapy can obliterate these malformations in 70% to 85% of cases (40). In approximately 85% of cases, the cortical venous drainage can be reversed (49).

Open Cranial Surgery

• Open cranial surgery outcomes: Open cranial surgery still has a role in the treatment of DAVFs, in certain locations (eg, the anterior fossa) and in patients in whom endovascular treatment was not successful (7). Data specific to the pediatric population is limited, but adult series of DAVFs treated with open cranial surgery have reported high obliteration rates of 94% to 100% with favorable clinical outcomes in 75% to 100% of patients (46,47,48). In one series of 24 high-grade DAVFs treated via microsurgery, the combined permanent morbidity and mortality rate was 17% (46).

Outcome After Nonsurgical Treatments

Radiosurgery

• Nonoperative treatment outcomes: The benefits of radiosurgery are delayed (up to 36 months) and obliteration rates of 55% to 80% have been reported (33).

Outcome After Multimodal Therapies

• Multimodality treatment carries benefits: Rates of occlusion can be increased and rates of associated morbidity and mortality reduced through multimodal treatment. A multidisciplinary approach remains necessary for a large subset of patients (41).