Endovascular treatment of tentorial dural arteriovenous fistulae: multicenter CONDOR study

Background Tentorial dural arteriovenous fistulas (TDAVFs) are among the most aggressive intracranial dAVFs. Contemporary multicenter endovascular outcome data remain limited. We evaluated endovascular efficacy, safety, and durability in the largest multicenter TDAVF cohort to date. Methods Data from 16 international centers were retrospectively analyzed. Treatment success was defined as complete angiographic obliteration or elimination of cortical venous drainage (CVD). Logistic regression and Kaplan–Meier analyses were performed. Outcomes were compared with a previously analyzed microsurgical TDAVF cohort. Results Among 161 TDAVFs, 122 (76%) were selected for endovascular treatment, and 119 underwent embolization (70% male; median age 59 years). Aggressive presentation occurred in 72%, and 97% demonstrated CVD. Median time from diagnosis to embolization was 1 day (IQR 0–26). Treatment success was achieved in 66% (78/119), including complete obliteration in 59% (70/119). Procedure-related complications occurred in 15%, with permanent neurological deficits in 6%. Compared with microsurgery, treatment success was lower after embolization (66% vs 90%; OR 5.59, 95% CI 2.03 to 15.0; P<0.01), while overall complication rates were similar (15% vs 11%; P=0.21). Microsurgery was associated with fewer permanent neurological deficits (2% vs 6%; OR 0.06, 95% CI 0.02 to 0.20; P<0.01). Outcome durability, including recurrence, new hemorrhage, and new non-hemorrhagic neurological deficit, did not differ between treatment modalities. Conclusions Endovascular treatment achieves treatment success in two-thirds of TDAVFs. However, microsurgery demonstrated higher cure rates and lower permanent neurological morbidity, supporting multidisciplinary treatment selection and consideration of microsurgical disconnection in anatomically favorable lesions.