Abstract
OBJECTIVE: To evaluate the surgical outcomes of microsurgical treatment and transarterial endovascular embolization for dural arteriovenous fistulas (DAVFs). METHODS: A retrospective analysis was conducted on 47 patients diagnosed with high-grade DAVFs (Cognard types 2b, 2a + b, 3, 4, and 5) between June 2019 and June 2022 at Nanjing Brain Hospital, affiliated with Nanjing Medical University. These patients underwent either microsurgery or endovascular embolization. Postoperative efficacy, surgical complications, and related prognostic factors were compared between the two groups. The primary endpoint was a postoperative modified Rankin Scale (mRS) score > 3. Secondary outcomes included angiographic confirmation of fistula occlusion, complication rates, and neurological deficits. RESULTS: In the microsurgical treatment group, complete fistula occlusion was achieved in 23 patients (85.185%), while 12 patients (60.000%) in the transarterial embolization group (single-session treatment) achieved complete occlusion. Although microsurgical treatment demonstrated a higher occlusion rate, this difference did not reach statistical significance (p=0.051). The median follow-up duration for all patients was 12 months (IQR 1-38 months). During follow-up, 2 patients (4.255%) with residual untreated fistulas developed severe neurological deficits. In contrast, none of the patients with single fistulas developed severe postoperative complications. CONCLUSION: Microsurgical treatment demonstrated a higher rate of complete fistula occlusion compared to single-session transarterial embolization in patients with DAVFs, although this difference was not statistically significant. Both treatment modalities showed acceptable safety profiles. Patients with single fistulas showed a lower risk of severe postoperative neurological deficits compared to those with multiple fistulas. This study provides important insights into the emergency treatment of DAVF. TRIAL REGISTRATION: Chinese Registry of Clinical Trials: ChiCTR2300072890.