1143 Clinical Presentation and Surgical Management of Tentorial Dural Arteriovenous Fistulae: An Analysis from the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR)

INTRODUCTION: Dural arteriovenous fistulae (dAVFs) are rare cerebrovascular anomalies. Tentorial dAVFs are more likely to have aggressive features, making them prone to symptomatic presentations and hemorrhage. METHODS: Patients from the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) database were queried for age at treatment, sex, comorbidities, clinical presentation, arterial anatomy, venous anatomy, Borden grade, and surgical approach. The primary efficacy endpoint utilized was complete surgical resection, while the primary safety endpoint was a composite endpoint including clinical complications related to the dAVF and return to the operating room for dAVF-related etiologies. To identify factors for each endpoint, a multivariable logistic regression for each endpoint was performed using stepwise backwards selection in SAS studio. The primary efficacy endpoint in our study was defined as complete surgical resection. RESULTS: 1241 dAVFs were available for analysis in the CONDOR database (59 tentorial dAVFs). Presentation included hemorrhage in 61% (36/59), non-hemorrhagic neurologic deficit in 31% (18/59), flow-related symptoms in 19% (11/59), and incidental presentation in 5% (3/59) of cases. Preoperative embolization was utilized in 61% (36/59) and complete surgical resection was achieved in 83% (49/59) of patients. Multivariable-analysis demonstrated prior stroke (p = 0.04) and presence of venous ectasia (p = 0.04) were associated with a lower likelihood of surgical success. Older age at treatment (p = 0.04) and use of antiplatelet medications (p = 0.02) were associated with the composite safety endpoint. CONCLUSIONS: Complete resection of tentorial dAVFs can be accomplished in a high number of these lesions. Surgical success was less common in patients with previous strokes and in dAVFs with venous ectasia. Older age at treatment and the use of antiplatelet medications were associated with clinical complications or return to the operating room.