• Stefanos Giannopoulos, Pavlos Texakalidis, Mohammad Alkhataybeh Redab Ahmad RA Department of Neurosurgery, King Abdullah University Hospital, Ar Ramtha, Jordan., Nektarios Charisis, Leonardo Rangel-Castilla, Pascal Jabbour, Jonathan A Grossberg, and Theofilos Machinis.
• Department of Surgery, 251 HAF and VA Hospital, Athens, Greece. Electronic address: stefanosgiannopoulosmed@gmail.com.
• World Neurosurg. 2019 Aug 1; 128: 593-599.e1.

BackgroundDural arteriovenous fistulas (DAVFs) in the anterior cranial fossa constitute approximately 1%-1.5% of intracranial vascular malformations. Depending on the drainage patterns, the diagnosis of ethmoidal DAVFs should prompt treatment because of the high risk of bleeding. Available treatments strategies are surgical treatment and the endovascular approach.ObjectiveTo compare the surgical treatment with the endovascular therapy in terms of complete obliteration and perioperative adverse events.MethodsThis study was performed according to the PRISMA guidelines. Eligible studies were identified through a search of PubMed and Cochrane until February 2019. A random effects model meta-analysis of odds ratios (OR) was conducted and the I-square was used to assess heterogeneity. Good outcome was defined as no neurologic deterioration within 30 days after the procedure.ResultsFive studies comprising 81 patients were included in the meta-analysis. Surgical disconnection was superior to endovascular therapy in terms of postprocedural complete obliteration rate (surgery group, 100% [n = 65/65]; endovascular therapy, 47% [n = 15/32]; OR, 32.19; 95% confidence interval, 5.46-189.72; I2 = 9.9%) and 30-day good outcome (surgery group, 98% [n = 63/64]; endovascular therapy, 47% [n = 15/32]; OR, 21.90; 95% confidence interval, 1.94-247.27; I2 = 53.6%). No significant differences in terms of 30-day stroke, transient ischemic attack; visual deficit, new-onset seizure, and intracranial hemorrhage were identified.ConclusionsSurgical treatment was superior to endovascular therapy in terms of complete obliteration and overall good outcome. Adverse event rates were similar between the 2 groups. Future studies should be conducted to validate our results.Copyright © 2019 Elsevier Inc. All rights reserved.

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