Natural history and treatment of XXXX .

@entity1 @entity510 @entity602 @entity409 @entity2457 @entity887 @entity1462
UNASSIGNED: @entity2457 ( @entity2457 ) located at the craniocervical junction are rare @entity1462 with distinctive features, and their natural history and the optimal treatment strategy remains unclear. We retrospectively reviewed eight @entity1 with craniocervical junction DAVF who were evaluated at our institution between 2009 and 2012. We also conducted a MEDLINE search for all reports of craniocervical junction DAVF between 1970 and 2013, and reviewed 119 @entity1 from 56 studies. From a total of 127 @entity1 , 46 (37.1%) presented with @entity602 , 53 (43.1%) with @entity510 ( @entity510 ), and four (3.3%) with @entity409 . @entity510 was typically mild, most often Hunt and Hess Grade I or II (83.3%), and associated with ascending venous drainage via the intracranial veins (p<0.001). Higher rates of obliteration were observed after microsurgery compared to embolization. Overall, younger age (odds ratio [OR] 1.07; 95% confidence interval [CI] 1.01-1.12; p=0.011), hemorrhagic presentation (OR 0.17; 95% CI 0.06-0.50; p=0.001), and microsurgery (OR 0.23; 95% CI 0.08-0.6; p=0.004) were independently predictive of good outcome at the last follow-up. Microsurgery was the only independent predictor of overall improvement at the last follow-up (OR 4.35; 95% CI 1.44-13.2; p=0.009). Prompt diagnosis and microsurgical management, offering a greater chance of immediate obliteration, may optimize the outcomes for @entity1 with craniocervical junction DAVF. Endovascular treatment is often not feasible due to lesion angioarchitecture, and is associated with a higher risk of lesion recanalization or recurrence. However, long term studies with newer @entity887 such as Onyx (ev3 Endovascular, Plymouth, MN, USA) are yet to be performed.
