Citations 2
Microsurgical management of tentorial dural arteriovenous fistula: an analysis from the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR)
Hallak, Hana , Connor, Michelle, Lanzino, Giuseppe, Kim, Louis, Levitt, Michael R., Samaniego, Edgar, Amin-Hanjani, Sepideh, Alaraj, Ali, Starke, Robert M., Abla, A, Koch, Matthew, Sheehan, Jason P., Gross, Bradley A., Satomi, J, Tada, Yoshiteru , Dijk, J. Marc C. van , Potgieser, Adriaan R. E., Bulters, Diederik O., Du, Rose, Lawton, Michael, Abecassis, Isaac Josh, Osbun, Joshua W., Zipfel, Gregory J., Bulters, Diederik , van DijK, J Marc C , Bulters, Diederik O , Lanzino, Giuseppe , Kim, Louis J. , Levitt, Michael R. , Hayakawa, M. , Amin-Hanjani, Sepideh , Alaraj, Ali , Starke, Robert M. , Koch, Matthew J. , Dagra, Abeer , Sheehan, Jason P. , Derdeyn, Colin P. , Gross, Bradley , Du, Rose , Lawton, Michael T. , Osbun, Joshua W , Zipfel, Gregory J.
Journal of Neurosurgery | April 17, 2026 | Volume: No volume available | Issue: No issue available | Pages: 1-12
OBJECTIVE Dural arteriovenous fistulas (dAVFs) are rare cerebrovascular anomalies. Tentorial dAVFs (TDAVFs) have more aggressive features, making them prone to symptomatic presentations and hemorrhage. TDAVFs are heterogenous and require tailored surgical approaches. Presented is a multicenter analysis of TDAVF surgical outcomes. METHODS The Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR) consortium compiled data on dAVFs from 16 international centers from 1990 to 2021 retrospectively. Microsurgical treatment success was defined as angiographically confirmed complete obliteration of the fistula or discontinuation of cortical venous drainage (CVD) in high-grade TDAVFs. TDAVF subtypes and tailored surgical approaches were reviewed. RESULTS Of 1360 patients in CONDOR, 161 had TDAVFs and 27% (44/161) of these patients underwent surgical management, with the majority (52% [23/44]) receiving surgery as a salvage treatment following failed embolization. The mean age (SD) of this cohort was 56 (15) years, and 68% (30/44) were male. In total, 91% (40/44) of surgically treated patients presented with aggressive symptoms: 64% (28/44) presented with hemorrhage and 27% (12/44) with nonhemorrhagic neurological deficit (NHND). The median (IQR) duration from symptom onset to diagnosis was 1 (1–4) day. The median time (IQR) between diagnosis and surgery was 15 (3–80) days. Surgical approaches varied across the cohort, with the retrosigmoid being the most common (44% [18/41]), followed by the midline suboccipital (24% [10/41]) and occipital (15% [6/41]) approaches. Perioperative complications occurred in 11% (5/44) of cases, as well as permanent neurological deficits in 2% (1/44). Surgical success was achieved in 90% of patients (38/42). During the mean 3-year follow-up, 2 patients experienced a recurrence of their fistula including representation of CVD (2/38 [5%]) and 1 patient had a new NHND (1/43 [2%]). Shorter symptom duration was significantly associated with success (15.6 vs 181.5 days, p = 0.001). Primary versus salvage microsurgery showed no difference in outcomes. Both patients with recurrent fistula were effectively treated with Gamma Knife radiosurgery. CONCLUSIONS Resection is safe and durable for the treatment of TDAVF not otherwise amenable to embolization. It can achieve a high degree of success with a low rate of perioperative complications and permanent neurological deficits, benefits far exceeding the risks associated with TDAVF natural history or management with less effective modalities.
Patient's Age Impact on Stroke Risk and Intracranial Aneurysm Occlusion: SCENT Flow Diverter Study—A Nonrandomized Clinical Trial on Large and Giant Aneurysms
Wakhloo, Ajay K. , Jenkins, Paul, Meyers, Philip M. , Coon, A , Kan, Peter T., Puri, Ajit S., Vries, Joost de, Lanzino, Giuseppe, Bain, Mark D., Ebersole, Koji , Welch, B, Dog⫧an, Aclan , Jabbour, Pascal M., Mocco, J., Siddiqui, Adnan H., Turk, Aquilla S., Taussky, Philipp, Hanel, Ricardo A., Investigators, for the SHaRe and IPHCC, Siddiqui, Adnan H. , Siddiqui, Adnan H , Coon, Alexander Lewis , Kan, Peter , Puri, Ajit S., Vries, Joost de , Lanzino, Giuseppe , Welch, Babu G. , Jabbour, Pascal , Turk, Aquilla S , Taussky, Philipp , Hanel, Ricardo A.
Neurosurgery Practice | April 17, 2026 | Volume: 7 | Issue: 2 | Pages: No page available
10.1227/neuprac.0000000000000222
BACKGROUND AND OBJECTIVES: The prospective single-arm nonrandomized SCENT (Surpass Intracranial Aneurysm Embolization System Pivotal) trial on flow diverter treatment of large and giant intracranial aneurysms (IA) was analyzed for patients' age and IA characteristics affecting stroke and occlusion rates over 5 years (Trial registration NCT01716117). METHODS: Impact on major ipsilateral stroke and IA occlusion was studied by stratifying age as 65 years and younger vs older than 65. Kaplan–Meier estimates of time to both endpoints, stratified by age, were created. Univariate predictors of time-to-stroke were analyzed using univariable proportional hazards regression models. Limited bivariable modeling was also attempted. RESULTS: Of 180 patients with large or giant IA enrolled, 119 were 65 years and younger, whereas 61 were older than 65 years. The 3-year risk of stroke for the older than 65 years group (19.7%) was more than double that of the 65 years and younger group (9.2%), P = .047. No new strokes were reported between 3 and 5 years. Four patients (2.2%) experienced aneurysm rupture within the first week post-treatment, 3 being 65 years and younger and the fourth older than 65 (>.99). Complete IA occlusion within age strata at 1 year was: older than 65 60% (33/55), 65 years and younger 79.1% (87/110), P = .009, 3 years: older than 65 67.6% (25/37), 65 years and younger 82.5% (66/80), P = .071, and 5 years: older than 65 85.7% (18/21), 65 years and younger 91.8% (56/61), P = .417. CONCLUSION: Age older than 65 was associated with an increased risk of stroke and predictive of incomplete healing and increased time to healing.