| Research Abstract |
Nationwide survey was carried out on the epidemiological aspect of dural arteriovenous fistulas (dAVFs) in Japan. The first questionnaire was sent to 1236 neurosurgical clinics (A or C-class clinics registered by the Japan Neurosurgcal Society) to ask the number of patients experienced between 1998-2002. 1815 cases were collected from 338 clinics. Location was the cavernous sinus (CS) in 46% of cases, transverse-sigmoid sinus (ITS) in 28%, spinal cord in 5.8%, superior sagittal sinus (SSS) in 5.3%, anterior cranial base (ACB) in 4.3%, craniocervical junction (CCJ) in 3.3%, tentorium in 3.2%, and others in 4.2%. The detection rate was 0.29 patients (per 100,000 persons per year). Second questionnaire was sent to 112 clinics which responded to the 1^<st> questionnaire, and 1490 cases were collected from 68 clinics. There were 628 men and 850 women and mean age was 62.7±12.7 years. Distribution of the lesion was similar to the prior questionnaire. Female dominancy was noted in CS lesion a
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nd male dominancy in ACB, tentorium, SSS, straight sinus (SS), spinal cord, and CCJ. Initial presentation was occulo-conjunctival symptoms in 65% of the patients, bleeding/infarction in 21%, tinnitus in 20%, increased intracranial pressure in 6%, spinal symptoms in 6%, and hydrocephalus in 0.4%. 6.5% of the patients were asymptomatic. Aggressive lesion was frequently seen in SSS, SS, inferior petrosal sinus and non-aggressive lesion in marginal, cavernous sinus, and condylar vein. Endovascular treatment was selected in 79% of the patients, surgical treatment in 13%, irradiation in 3.4%, and conservative treatment in 11%. Complete angiographic obliteration was obtained in 59% of the patients, subtotal in 16%, partial in 13%. Clinical outcome was full recovery in 54%, improvement in 16%, unchanged in 7%, aggravation in 1.5%, and death in 1.2%. Low obliteration rate and unfavorable outcome were characteristic features in the tentorial lesion, and unfavorable outcome against high obliteration rate in the spinal lesion. Less
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