{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:06:18Z","timestamp":1780131978347,"version":"3.54.0"},"reference-count":44,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Endovascular and microsurgical treatment are viable options for the majority of Borden type III dural arteriovenous fistulas (dAVFs). The aim of this study was to examine treatment outcomes in a comparative analysis of endovascular and surgical treatment modalities for Borden type III fistulas and explore clinical implications of the DES scheme in selecting ideal candidates for surgical therapy.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Patients diagnosed with dAVFs with leptomeningeal venous drainage admitted to the Departments of Neurosurgery or Neuroradiology of the University Hospital Zurich between January 2014 and October 2021 were included in this study. Comprehensive patient data including demographics, clinical presentation, and dAVF characteristics, including established classifications, were collected. Treatment outcomes were assessed based on postinterventional angiography findings. In addition, treatment-related complications were assessed based on the Clavien-Dindo classification.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Among all Borden type III dAVFs, 15 were initially treated endovascularly (60% complete occlusion rate) and 10 with microsurgical disconnection (90% complete occlusion rate) (p = 0.18). Subgroup analysis of dAVFs meeting the criteria for directness and exclusivity based on the DES scheme showed a 100% complete occlusion rate after microsurgical disconnection, whereas embolization achieved a complete occlusion rate of 60% (p = 0.06). There was no significant difference in the rate or severity of treatment-related complications between treatment modalities.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n This study suggests that microsurgical disconnection is a viable primary treatment modality for Borden type III dAVFs, particularly for dAVFs that meet the criteria of directness and exclusivity according to the DES scheme. The DES scheme demonstrates its relevance in selecting the most appropriate treatment strategy for affected patients.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2023.12.focus23788","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T07:00:45Z","timestamp":1709276445000},"page":"E11","source":"Crossref","is-referenced-by-count":0,"title":["Treatment outcomes and the role of the DES scheme in the appropriate treatment selection for high-grade dural arteriovenous fistulas"],"prefix":"10.3171","volume":"56","author":[{"given":"Benjamin","family":"Beyersdorf","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanos","family":"Voglis","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoming","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Sarnthein","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Regli","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menno R.","family":"Germans","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Switzerland; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"AJNR Am J Neuroradiol","first-page":"1007","article-title":"Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment","volume":"33","author":"Gandhi D","year":"2012","unstructured":"Gandhi D, Chen J, Pearl M, Huang J, Gemmete JJ, Kathuria S. Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. AJNR Am J Neuroradiol. 2012;33(6):1007\u20131013."},{"issue":"5","key":"b2","series-title":"Stroke","first-page":"1424","article-title":"Intracranial dural arteriovenous fistulae","volume":"48","author":"Reynolds MR","year":"2017","unstructured":"Reynolds MR, Lanzino G, Zipfel GJ. Intracranial dural arteriovenous fistulae. Stroke. 2017;48(5):1424\u20131431."},{"key":"b3","article-title":"Handbook of Skull Base Surgery","author":"Di Ieva A","year":"2016","unstructured":"Di Ieva A, Lee JM, Cusimano MD. Handbook of Skull Base Surgery. Thieme; 2016."},{"issue":"5","key":"b4","series-title":"Stroke","first-page":"1233","article-title":"Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux","volume":"33","author":"van Dijk JMC","year":"2002","unstructured":"van Dijk JMC, terBrugge KG, Willinsky RA, Wallace MC. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke. 2002;33(5):1233\u20131236."},{"issue":"7","key":"b5","series-title":"Stroke","first-page":"2017","article-title":"Intracranial dural arteriovenous fistulae: clinical presentation and management strategies","volume":"46","author":"Miller TR","year":"2015","unstructured":"Miller TR, Gandhi D. Intracranial dural arteriovenous fistulae: clinical presentation and management strategies. Stroke. 2015;46(7):2017\u20132025."},{"issue":"3","key":"b6","series-title":"Neurosurgery","first-page":"332","article-title":"Dural arteriovenous malformations and intracranial hemorrhage","volume":"15","author":"Malik GM","year":"1984","unstructured":"Malik GM, Pearce JE, Ausman JI, Mehta B. Dural arteriovenous malformations and intracranial hemorrhage. 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Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke. 2002;33(5):1233\u20131236."},{"issue":"7","key":"b5","series-title":"Stroke","first-page":"2017","article-title":"Intracranial dural arteriovenous fistulae: clinical presentation and management strategies","volume":"46","author":"Miller TR","year":"2015","unstructured":"Miller TR, Gandhi D. Intracranial dural arteriovenous fistulae: clinical presentation and management strategies. Stroke. 2015;46(7):2017\u20132025."},{"issue":"3","key":"b6","series-title":"Neurosurgery","first-page":"332","article-title":"Dural arteriovenous malformations and intracranial hemorrhage","volume":"15","author":"Malik GM","year":"1984","unstructured":"Malik GM, Pearce JE, Ausman JI, Mehta B. Dural arteriovenous malformations and intracranial hemorrhage. 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Neurosurg Rev. 2015;38(2):273\u2013281."},{"issue":"4","key":"b11","series-title":"J Neurosurg","first-page":"767","article-title":"Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion","volume":"97","author":"Satomi J","year":"2002","unstructured":"Satomi J, van Dijk JMC, Terbrugge KG, Willinsky RA, Wallace MC. Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion. J Neurosurg. 2002;97(4):767\u2013770."},{"issue":"9","key":"b12","series-title":"Acta Neurochir (Wien)","first-page":"1775","article-title":"Cranial dural arteriovenous shunts: selection of the ideal lesion for surgical occlusion according to the classification system","volume":"161","author":"Baltsavias G","year":"2019","unstructured":"Baltsavias G, Valavanis A, Regli L. 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Neurosurgery outcomes and complications in a monocentric 7-year patient registry. Brain Spine. 2022;2:100860."},{"issue":"3","key":"b15","series-title":"Radiology","first-page":"671","article-title":"Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage","volume":"194","author":"Cognard C","year":"1995","unstructured":"Cognard C, Gobin YP, Pierot L, Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995;194(3):671\u2013680."},{"issue":"2","key":"b16","series-title":"Ann Surg","first-page":"187","article-title":"The Clavien-Dindo classification of surgical complications: five-year experience","volume":"250","author":"Clavien PA","year":"2009","unstructured":"Clavien PA, Barkun J, de Oliveira ML, The Clavien-Dindo classification of surgical complications: five-year experience. 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J Neurosurg. 1984;60(5):1059\u20131066."},{"key":"b19","series-title":"World Neurosurg","first-page":"593","article-title":"Treatment of ethmoidal dural arteriovenous fistulas: a meta-analysis comparing endovascular versus surgical treatment","volume":"128","author":"Giannopoulos S","year":"2019","unstructured":"Giannopoulos S, Texakalidis P, Mohammad Alkhataybeh RA, Treatment of ethmoidal dural arteriovenous fistulas: a meta-analysis comparing endovascular versus surgical treatment. World Neurosurg. 2019;128:593\u2013599.e1."},{"issue":"4","key":"b20","series-title":"J Neurosurg","first-page":"962","article-title":"Intervention for unruptured high-grade intracranial dural arteriovenous fistulas: a multicenter study","volume":"136","author":"Chen CJ","year":"2021","unstructured":"Chen CJ, Buell TJ, Ding D, Intervention for unruptured high-grade intracranial dural arteriovenous fistulas: a multicenter study. J Neurosurg. 2021;136(4):962\u2013970."},{"issue":"1","key":"b21","series-title":"Acta Neurochir (Wien)","first-page":"151","article-title":"Endovascular versus surgical treatment of cranial dural arteriovenous fistulas: a single-center 8-year experience","volume":"164","author":"Sorteberg W","year":"2022","unstructured":"Sorteberg W, Sorteberg A, Jacobsen EA, R\u00f8nning P, Nome T, Eide PK. Endovascular versus surgical treatment of cranial dural arteriovenous fistulas: a single-center 8-year experience. 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