Comparative Outcomes of Endovascular vs. Surgical Treatment in Craniocervical Junction Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis

Introduction: Craniocervical junction dural arteriovenous fistulas (CCJ-DAVFs) are rare and complex vascular malformations that are challenging to diagnose and treat. This study aims to compare surgical and endovascular treatments for CCJ-DAVFs through a systematic review and meta-analysis.

Methods: A systematic review and meta-analysis was conducted according to the PRISMA guidelines. PubMed, Scopus, and Web of Science databases were searched from inception to July 2024.

Results: Fifteen studies involving 266 patients were included. Of these, 143 (53.8%) patients underwent surgical treatment alone and 123 (46.2%) underwent endovascular treatment alone. In the surgical group, the complete obliteration rate at last follow-up was 89.8%. Retreatment rate was 6.2%. Periprocedural complications occurred in 21.6% of cases. In the endovascular group, the complete occlusion rate at last follow-up was 73.6%. Retreatment rate was 46.7%. Periprocedural complications occurred in 18.8% of cases. Comparative meta-analysis revealed that the rate of complete obliteration at last follow-up was significantly higher in the surgical group (OR: 0.24; CI: 0.07 to 0.89, p = 0.03). Surgical treatment had a significantly higher successful treatment rate (OR: 0.24; CI: 0.07 to 0.89, p = 0.03) and lower retreatment rate (OR: 37.13; CI: 6.31 to 218.59, p < 0.01). No significant differences were observed between the groups in terms of periprocedural complications or complete resolution of symptoms.

Conclusion : Surgical treatment for CCJ-DAVFs achieves higher rates of complete obliteration with lower retreatment rates compared to endovascular treatment. However, endovascular treatment showed a tendency towards reducing periprocedural complications while increasing the likelihood of complete resolution of symptoms. Individualized treatment plans for CCJ-DAVFs, should be considered according to their anatomical location and potential surgical accessibility. Further studies are required to confirm these findings.