Anatomical and Ophthalmic Clinical Outcomes of Endovascular Treatment for Dural Arteriovenous Fistulas (DAVFs), 13 years’ Experience in a Single Institute.
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Abstract
Background: Dural arteriovenous fistulas (DAVFs) are abnormal communications between the dural arteries and venous sinuses or cortical veins. Cerebral angiography remains the diagnostic and therapeutic gold standard. Variation in time to endovascular embolization may affect ocular outcomes. This study aimed to evaluate the relationship between treatment timing and clinical outcomes in DAVF patients.
Methods: This retrospective cohort included 102 eyes from 85 patients with angiographically confirmed DAVFs who underwent endovascular embolization between January 2009 and August 2022. Patients without ocular symptoms or with incomplete follow-up were excluded. Main outcomes—best corrected visual acuity (BCVA), intraocular pressure (IOP), and proptosis—were assessed at baseline, day 1, month 1, and month 3 post-treatment.
Results: Cognard types IIa (32.4%) and IIa + IIb (31.4%) were most frequent. Mean IOP improved significantly on day 1 in the < 4-week (P = 0.014) and 4-8-week (P = 0.043) groups compared with > 8 weeks. At 1 month, IOP changes were not significant in any group. At 3 months, mean IOP again improved significantly in the < 4-week (P = 0.001) and 4-8-week (P = 0.009) groups versus > 8 weeks. BCVA and proptosis showed no significant differences among duration groups.
Conclusion: Endovascular embolization yields excellent anatomical and functional outcomes in DAVFs. Early intervention within 8 weeks produces faster and greater IOP improvement, underscoring the importance of prompt diagnosis and treatment to prevent irreversible ocular damage. These findings support timely referral pathways and prospective studies to determine the optimal treatment window.
Conflicts of Interest: None
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