Intracranial haemorrhage in dural arteriovenous fistula

I read the article by Brzozowski et al. about the percentage of intracranial haemorrhage in type I dural arteriovenous fistula with great interest [1]. In the paper, the authors demonstrated that 50% of patients with dural arteriovenous fistula presented with intracranial haemorrhage. However, the results of the paper were not concordant with the already published data in some larger studies (n = 236-1075), which have demonstrated a risk of intracranial haemorrhage between 12% and 23.7% [2-5] (Table 1). In the paper published by Li et al., only two cases out of the reported 91 with Borden type I (Cognard type I and type IIa) dural arteriovenous fistulas presented with an intracranial haemorrhage, as compared to 28.6% in the authors’ paper. The sample size of the study and the inclusion of only those patients who were managed with embolisation probably contributed to this discrepancy.

Disclosure

The author declares no conflict of interests.

References

1. Brzozowski K, Narloch J, Piasecki P, et al. Are type I dural arteriovenous fistulas safe? Single-centre experience of endovascular treatment of dural arteriovenous fistulas. Pol J Radiol 2019; 84: 179-184.
2. Li C, Wang Y, Li Y, et al. Clinical and angioarchitectural risk factors associated with intracranial hemorrhage in dural arteriovenous fistulas: a single-center retrospective study. PLoS One 2015; 10: e0131235.
3. Singh V, Smith WS, Lawton MT, et al. Risk factors for hemorrhagic presentation in patients with dural arteriovenous fistulae. Neurosurgery 2008; 62: 628-635.
4. Hiramatsu M, Sugiu K, Hishikawa T, et al. Epidemiology of dural arteriovenous fistula in Japan: Analysis of Japanese Registry of Neuro­endovascular Therapy (JR-NET2). Neurol Med Chir (Tokyo) 2014; 54: 63-71.
5. Piippo A, Niemelä M, van Popta J, et al. Characteristics and long-term outcome of 251 patients with dural arteriovenous fistulas in a defined population. J Neurosurg 2013; 118: 923-934.

Correspondence address:
Tushar Garg, Seth GS Medical College & KEM Hospital, 1502, Nakshatra Building, Parel, Mumbai, India, e-mail: gargtushark@outlook.com


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