{
  "abstract": "Background Tentorial dural arteriovenous fistulas (TDAVFs) are rare but high risk vascular lesions. Although endovascular embolization is often the preferred treatment, large scale data on efficacy and safety are limited.Objective To investigate the efficacy and safety of endovascular treatment for TDAVFs in a large, retrospective, multicenter cohort, and to analyze lesion characteristics and outcomes according to TDAVF location.Methods Clinical, radiological, and interventional data from 585 patients treated in 32 international centers in 758 endovascular treatment sessions between 2012 and 2022 were analyzed. Patient demographics, fistula characteristics, endovascular treatment techniques, complications, and outcomes were assessed. Efficacy was measured by occlusion rates, safety by symptomatic complications, and modified Rankin Scale (mRS) scores.Results In 31.3% of cases TDAVFs initially presented with hemorrhage, including 12.8% in low grade TDAVFs (absence of cortical venous reflux). Transarterial embolization was the primary approach in 84.7% of sessions. Complete occlusion was achieved in 74.2% of cases after the last treatment and 85.7% at the last imaging follow-up (mean 20.9 months). Symptomatic complications occurred in 9.4% of patients, with 2.6% permanent deficits and 1.0% mortality. At the last clinical follow-up (mean 30.6 months), 89.2% of patients had good functional outcome (mRS score 0–2). Location was significantly associated with fistula grade (eg, galenic and tentorial sinus TDAVFs being more often high grade, and torcular TDAVFs being more often low-grade).Conclusions This large multicenter series demonstrated high occlusion rates, favorable functional outcomes, and acceptable complication rates, supporting endovascular therapy as a treatment of choice for TDAVFs. Considerable hemorrhage rates in low grade TDAVFs support the treatment even in the absence of cortical venous reflux.",
  "authors": [
    {
      "affiliations": [
        "Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany"
      ],
      "name": "Dominik F Vollherbst"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany"
      ],
      "name": "Nadja Krug"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China",
        "China International Neuroscience Institute (CHINA-INI), Beijing, China"
      ],
      "name": "Peng Zhang"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China",
        "China International Neuroscience Institute (CHINA-INI), Beijing, China"
      ],
      "name": "Yongjie Ma"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China",
        "China International Neuroscience Institute (CHINA-INI), Beijing, China"
      ],
      "name": "Xin Su"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy"
      ],
      "name": "Nicola Limbucci"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, Careggi University Hospital, Florence, Italy"
      ],
      "name": "Leonardo Renieri"
    },
    {
      "affiliations": [
        "Division of Neuroradiology, JDMI, UMIT, and University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Pascal J Mosimann"
    },
    {
      "affiliations": [
        "Division of Neuroradiology, JDMI, UMIT, and University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Alexandre Boutet"
    },
    {
      "affiliations": [
        "Division of Neuroradiology, JDMI, UMIT, and University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada"
      ],
      "name": "How-Chung Cheng"
    },
    {
      "affiliations": [
        "Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France"
      ],
      "name": "Gaultier Marnat"
    },
    {
      "affiliations": [
        "Neuroradiology Department, Bordeaux University Hospital, Bordeaux, France"
      ],
      "name": "Xavier Barreau"
    },
    {
      "affiliations": [
        "Department of Neurosurgery and Neurointerventions, Semmelweis University, Budapest, Hungary"
      ],
      "name": "Istvan Szikora"
    },
    {
      "affiliations": [
        "Department of Neurosurgery and Neurointerventions, Semmelweis University, Budapest, Hungary"
      ],
      "name": "Máté Czencz"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, University Hospital Virgen del Rocio, Seville, Spain"
      ],
      "name": "Alejandro González"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology, University Hospital Virgen del Rocio, Seville, Spain"
      ],
      "name": "Asier de Albóniga-Chindurza"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Henri Mondor Hospital, Créteil, France"
      ],
      "name": "Luca Scarcia"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Henri Mondor Hospital, Créteil, France"
      ],
      "name": "Erwah Kalsoum"
    },
    {
      "affiliations": [
        "UOSD Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy"
      ],
      "name": "Andrea M Alexandre"
    },
    {
      "affiliations": [
        "UOSD Neuroradiologia Interventistica, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy",
        "Università Cattolica del Sacro Cuore, Rome, Italy"
      ],
      "name": "Alessandro Pedicelli"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France"
      ],
      "name": "Raoul Pop"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France"
      ],
      "name": "Dan Mihoc"
    },
    {
      "affiliations": [
        "Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"
      ],
      "name": "Bettina Serrallach"
    },
    {
      "affiliations": [
        "Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland"
      ],
      "name": "Tomas Dobrocky"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany"
      ],
      "name": "Ansgar Berlis"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, Augsburg, Germany"
      ],
      "name": "Christoph Johannes Maurer"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France"
      ],
      "name": "Frédéric Clarençon"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France"
      ],
      "name": "Kevin Premat"
    },
    {
      "affiliations": [
        "Department of Neurology, Vascular Neurology Division, Institute of Neurological Research, FLENI, Buenos Aires, Argentina"
      ],
      "name": "Virginia Pujol Lereis"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Pontifical Xaverian University and Hospital Universitario San Ignacio, Bogotá, Colombia"
      ],
      "name": "Diego A Devia"
    },
    {
      "affiliations": [
        "Monash Neurointerventional Radiology, Monash Medical Centre, Melbourne, Victoria, Australia",
        "Interventional Radiology, Department of Radiology, Sant’Anna Hospital, Como, Italy"
      ],
      "name": "Sara Protto"
    },
    {
      "affiliations": [
        "Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada"
      ],
      "name": "Gwynedd E Pickett"
    },
    {
      "affiliations": [
        "Department of Interventional Neuroradiology and Neurosurgery, Instituto Médico ENERI Clínica La Sagrada Familia, Jose Hernandez, Buenos Aires, Argentina"
      ],
      "name": "Ivan Lylyk"
    },
    {
      "affiliations": [
        "Clinic of Radiology, Comenius University’s Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia"
      ],
      "name": "Kamil Zeleňák"
    },
    {
      "affiliations": [
        "Department of Data Science, Hyogo Medical University, Nishinomiya, Japan"
      ],
      "name": "Takeshi Morimoto"
    },
    {
      "affiliations": [
        "Department of Diagnostic and Interventional Neuroradiology, Tours University Hospital, Tours, France"
      ],
      "name": "Fouzi Bala"
    },
    {
      "affiliations": [
        "Scientific-Practical Centre of Endovascular Neuroradiology NAMS of Ukraine, Kyiv, Ukraine"
      ],
      "name": "Mykola Vyval"
    },
    {
      "affiliations": [
        "Interventional Neuroradiology Department, ULS São José, Hospital São José, Lisboa, Portugal"
      ],
      "name": "Rui Carvalho"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Oxford University Hospital NHS foundation Trus, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"
      ],
      "name": "Davide Simonato"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Marios-Nikos Psychogios"
    },
    {
      "affiliations": [
        "Department of Radiology, Necmettin Erbakan University, Meram Medical Faculty, Meram, Turkey"
      ],
      "name": "Osman Koc"
    },
    {
      "affiliations": [
        "Division of Neurointerventional Radiology, Department of Radiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA"
      ],
      "name": "Ajit S Puri"
    },
    {
      "affiliations": [
        "Department of Neurological Surgery, Radiology, Neurosciences, Pharmacology, University of Miami School of Medicine, Miami, Florida, USA"
      ],
      "name": "Robert M Starke"
    },
    {
      "affiliations": [
        "Department of Interventional Radiology, Turku University Hospital and University of Turku, Turku, Finland"
      ],
      "name": "Riitta Rautio"
    },
    {
      "affiliations": [
        "Section of Interventional Neuroradiology, University Hospital of Münster, Münster, Germany"
      ],
      "name": "Mostafa Ergawy"
    },
    {
      "affiliations": [
        "Departments of Neurosurgery and Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA"
      ],
      "name": "Jesse Jones"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, University and University Hospital Basel, Basel, Switzerland",
        "Department of Radiology and Neuroradiology, Stadtspital Zürich, Zürich, Switzerland"
      ],
      "name": "Peter B Sporns"
    },
    {
      "affiliations": [
        "Institute of Diagnostic and Interventional Neuroradiology, RKH Kliniken Ludwigsburg, Ludwigsburg, Germany"
      ],
      "name": "Stephan Meckel"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany"
      ],
      "name": "Sophia Hohenstatt"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany"
      ],
      "name": "Martin Bendszus"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA",
        "Neurointerventional and Neuroanalytics Consortium (NAN-C), School of Medicine, Toronto Metropolitan University, Toronto, Ontario, Canada"
      ],
      "name": "Adam A Dmytriw"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany"
      ],
      "name": "Markus A Möhlenbruch"
    }
  ],
  "title": "Endovascular embolization of tentorial dural arteriovenous fistulas (EMBOTENT): a retrospective multicenter study",
  "uid": "8f3ca0dd-7036-5cae-a5d4-bfed3bebf8d0"
}