A new subtype of intracranial dural AVF according to the patterns of venous drainage

Abstract

Background and purpose A well-known classification of dural arteriovenous fistulas (DAVFs) according to the patterns of venous drainage was described in 1977 by Djindjian, Merland et al. and later revised by Cognard, Merland et al. in 1995. They described 5 types of DAVFs assuming that the type of venous drainage is directly correlated with neurologic symptoms and in particular with hemorrhagic risk. We present a series of cases that combines type IV (DAVF with cortical venous drainage associated with venous ectasia) and type V (DAVF with spinal venous drainage), which we named type IV + V. Materials and methods A retrospective study between 2012 and 2020 in 2 Hospitals was performed on patients that met inclusion criteria for a diagnosis of this type of DAVF. Demographics, location, clinical presentation and outcomes of endovascular embolization were studied. Results Five (2,3%) patients out of 220 had a type IV + V DAVF. All cases had an aggressive presentation, either subarachnoid hemorrhage, myelopathy or both. All patients were treated with endovascular transarterial embolization achieving complete angiographic occlusion in one session and total remission of symptoms at 3 months. Conclusions This rare type of DAVF, combines two aggressive venous drainage patterns. For that reason, patients with type IV+V DAVF probably have a more aggressive natural history and worst outcome due to risk of intracranial and/or spinal hemorrhage and myelopathy, thus requiring urgent diagnostic and treatment. Larger studies are needed to better understand this type of DAVF.

WITHDRAWN: Modified Borden Grading System For Cranial And Spinal Dural Arteriovenous Fistulas In Neuroendovsacular Era

“…Classi cations developed by Borden et al and Cognard et al have both inadequately distinguish between anterior and posterior drainage in the cavernous sinus region, which is the most common DAVF location(4,11, 16,25,27). We de ne cavernous sinus DAVFs drained only inferior petrosal sinus and spinal extradural DAVFs only involving epidural venous plexus as type I DAVFs.…”

Diagnostik und Behandlung von duralen AV-Fisteln

“…Dieser Typ wurde aktuell von Casasco beschrieben und vereint die Eigenschaften der Typen IV und V, also die kortikale Drainage mit venöser Ektasie und die spinale Drainage [14].…”

Update on Management of Dural Arteriovenous Fistulas

“…There is no clear sex predilection, and there is heterogeneity within the age of presentation, but patients commonly present in the 5th and 6th decades of life [13][14][15][16][17][18]. There is debate surrounding the formation mechanism; however, it is universally accepted that most of these lesions develop idiopathically [19][20][21]. Herein lies the challenge of detecting these lesions as they are without a true, primary, identifiable cause.…”

“…High-grade dAVF are defined by the presence of cortical venous drainage (CVD) and are associated with significant mortality and morbidity. They are aggressive lesions with elevated risks of intracranial hemorrhage (ICH) and non-hemorrhagic neurological deficits (NHND) [13,20,23,[28][29][30]. In high-grade dAVF, the risk of ICH is reportedly as high as 20% [13].…”

“…In high-grade dAVF, the risk of ICH is reportedly as high as 20% [13]. Furthermore, if left untreated, the risk of rebleeding after ICH in a ruptured dAVF is 35% within the first two weeks [13,20,31,32]. NHND includes seizures, focal nerve deficits, mental status changes, and progressive myelopathy; symptoms will vary with location [3,19,24,27].…”