Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.

Cognard, Christophe; Gobin, Y. Pierre; Piérot, Laurent; Bailly, A.; Houdart, Emmanuel; Casasco, A.; Chiras, J.; Merland, J. J.

doi:10.1148/radiology.194.3.7862961

Cited by 1,433 publications

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“…11,18) Six of a series of 12 patients with type V dAVFs had myelopathy with slow-flow spinal perimedullary venous drainage that extended to the thoracic or lumbar spinal cord. 5) The other six patients without myelopathy (five with hemorrhages, one with focal neurological deficit) had spinal venous drainage limited to the cervical cord, as a cervical radiculomedullary vein drained the arterialized flow from the dAVF into the epidural space. This type of drainage is thought to prevent spinal cord venous hypertension and myelopathy.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Ezura

Takahashi

et al. 2004

Neurol. Med. Chir.(Tokyo)

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A 73-year-old man presented with a rare transverse sinus dural arteriovenous fistula (dAVF) with venous reflux to the brainstem and medulla manifesting as brainstem and spinal cord edema mimicking brainstem infarction. Complete occlusion of the fistula was achieved by transvenous embolization, resulting in angiographic cure of the fistula and progressive improvement of the symptoms. Intracranial dAVFs with perimedullary venous drainage, type V according to the Cognard classification, are rare lesions with distinctive clinical, radiological, and therapeutic aspects. This case demonstrates that the symptoms of dAVF with perimedullary venous reflux are variable, so dAVF should be considered in patients with clinical and radiological findings suggestive of congestion in the brainstem and spinal cord. Dysfunction of the medulla and spinal cord caused by venous hypertension is the most probable cause of the neurological symptoms in such cases. Interventional therapy can lead to angiographic cure and resolution of the symptoms.

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Section: Discussionmentioning

confidence: 99%

Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Ezura

Takahashi

et al. 2004

Neurol. Med. Chir.(Tokyo)

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“…hage [1][2][3] . The natural history of these high grade lesions has shown to yield a high annual mortality and morbidity rate if untreated 4 .…”

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confidence: 99%

Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

Chew

Weill

Guilbert

et al. 2009

Can. j. neurol. sci.

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Intracranial dural arteriovenous fistulas (DAVFs) are lesions with a heterogeneous clinical course, related to the varying patterns of venous drainage. Dural arteriovenous fistulas without cortical venous involvement tend to be relatively benign in course, while lesions with cortical venous drainage (whether direct or via reflux from dural venous sinuses) are more aggressive, having a higher rate of clinical presentation with aggressive neurological symptoms and intracranial haemorr-ABSTRACT: Purpose: To present our experience with the endovascular management of intracranial dural arteriovenous fistulas with direct cortical venous drainage by trans-arterial embolisation using Onyx. Materials & Methods: Between January 2004 and April 2008, 12 consecutive high grade intracranial dural arteriovenous fistulas (Cognard type III (eight patients) or IV (three patients)) were treated by trans-arterial embolisation with Onyx. The majority of cases were treated by Onyx embolisation alone. One case had additional embolisation with n-butyl-2-cyanoacrylate at the same session. Imaging follow-up was obtained in all but one patient (mean 3.6 months). Results: Nine patients had a technical success at the end of the embolisation procedure with complete angiographic exclusion of the fistula. Two patients had a small residual fistula at the end of embolisation, one of which had residual mild cortical venous drainage. Both were stable at follow-up angiography. One patient had a residual fistula supplied by the ophthalmic artery, which was thought to be unsafe to embolise and was sent for surgery, which was curative. In one patient the microcatheter ruptured, with a fragment of the distal microcatheter left in the occipital artery. No clinical complications were observed in this series at clinical follow-up (mean 3.3 months). Two patients were noted to have significant radiation dose. Conclusion: Endovascular management of intracranial dural arteriovenous fistulas with direct venous cortical drainage by trans-arterial Onyx embolisation is a safe and effective treatment according to our experience. Fluoroscopy times and radiation dose may be a concern. Chez un patient une embolisation additionnelle de n-butyl-2-cyanoacrylate (nBCA) a été effectuée au cours de la même session. Une imagerie a été obtenue chez tous les patients sauf un au cours du suivi (moyenne de 3,6 mois). Résultats : Nous avons obtenu un succès technique chez neuf patients à la fin de l'embolisation, avec exclusion angiographique complète de la fistule. Deux patients avaient une petite fistule résiduelle à la fin de l'embolisation, dont un présentait un léger drainage veineux cortical résiduel. Ces deux patients étaient stables à l'angiographie de suivi. Un patient avait une fistule résiduelle nourrie par l'artère ophtalmique dont l'embolisation a été jugée trop risquée. Il a été référé en chirurgie et l'intervention a été un succès. Chez un patient, le microcathéter s'est rompu et un fragment distal du microcathéter s'est logé dans l'artère occipitale. Il a été lai...

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“…The potential invisibility of slow flow DAVFs in the TOF modality has been discussed previously; however, the heightened sensitivity of the respective source images has been emphasized [1,2]. In our patient, both TOF-MRA and the source images were unremarkable.…”

Section: Sirmentioning

confidence: 46%

Now you see it, now you don’t—the hidden life of cerebral dural arteriovenous fistulae

Brasse

Roth²,

Fritzsch

et al. 2008

Neuroradiology

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Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.

Abstract: This classification provides useful data for determination of the risk with each dural AVF and enables decision-making about the appropriate therapy.

Cited by 1,433 publications

References 0 publications

Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Arterial Onyx Embolisation of Intracranial DAVFs with Cortical Venous Drainage

Now you see it, now you don’t—the hidden life of cerebral dural arteriovenous fistulae

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