E-004 Cranial dural arteriovenous fistulas: asymptomatic cortical venous drainage portends less aggressive clinical course

Abstract

ObjectiveCranial dural arteriovenous fistulas (dAVFs) with cortical venous drainage (CVD) (Borden type 2 and 3) are reported to carry a 15% annual risk of intracranial hemorrhage (ICH) or non-hemorrhagic neurological deficit (NHND). The purpose of this study is to compare the clinical course of type 2 and 3 dAVFs that present with ICH or NHND versus those that do not.Methods28 patients with type 2 or 3 dAVFs were retrospectively evaluated. CVD was classified as asymptomatic (aCVD) if patients presented incidentally or with pulsatile tinnitus or orbital phenomena. CVD was classified as symptomatic (sCVD) if patients presented with ICH or NHND. Occurrence of new ICH or new or worsening NHND between diagnosis and disconnection of CVD or last follow-up (if not disconnected) was noted. Overall frequency of events was compared using Fisher's exact test. Cumulative event free survival was compared using Kaplan–Meier analysis with log rank testing.ResultsOf 17 patients with aCVD, one (5.9%) developed ICH and none experienced NHND or death during the mean 4.1 years of follow-up. Of 11 patients with sCVD, two (18.2%) developed ICH and three (27.3%) suffered new or worsened NHND over the mean 2.4 years of follow-up. One of these patients subsequently died. Overall frequency of ICH or NHND was significantly lower in patients with aCVD versus sCVD (p=0.022). Respective annual event rates were 1.4% versus 19.0%. aCVD patients had significantly higher cumulative event free survival (p=0.0016).ConclusionCranial dAVFs with aCVD may have a less aggressive clinical course than those with sCVD.

Transarterial Onyx Embolization of Cranial Dural Arteriovenous Fistulas: Long-Term Follow-Up

“…It has been reported that patients presenting with benign (incidental/pulsatile tinnitus/orbital phenomena) symptoms from cDAVFs with CVD may be at lower annual risk for intracranial hemorrhage (approximately 1.5%) compared with those presenting with aggressive neurologic symptoms. [14][15][16] However, these estimates are based on small patient numbers or short follow-up periods. In the series by Strom et al, 15 1 of 17 patients presenting with benign symptoms from persistent CVD bled 13 years later.…”

“…[14][15][16] However, these estimates are based on small patient numbers or short follow-up periods. In the series by Strom et al, 15 1 of 17 patients presenting with benign symptoms from persistent CVD bled 13 years later. In another series by Söderman et al, 14 a complicated "time-at-risk" period was calculated by combining the time between symptom onset/nonangiographic diagnosis, the time between diagnostic angiography and treatment, and clinical follow-up.…”

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

“…Strom et al reported a similar annual hemorrhage rate of 1.4% in 17 patients harboring DAVFs with CVD without prior hemorrhage. 45 The risk increased to 7.6% in those with DAVFs with CVD who presented with hemorrhage or nonhemorrhagic neurological deficit. Detailed analyses by Gross and Du of published studies found 6% and 10% annual hemorrhage rates for Borden Types II and III DAVFs, respectively, in contrast to an annual hemorrhage rate of 0% for Borden Type I DAVFs.…”

The putative role of the venous system in the genesis of vascular malformations

“…12, 63,70 Morbidity correlates more with the severity of DAVF retrograde cortical venous reflux as classified by the Borden and Cognard grading systems, and not necessarily the location of the DAVF. 4,10,15,24,34 In patients with DAVFs with cortical venous reflux, the annual rate of intracranial hemorrhage or nonhemorrhagic neuro logical deficit is 15-19%.…”

“…4,10,15,24,34 In patients with DAVFs with cortical venous reflux, the annual rate of intracranial hemorrhage or nonhemorrhagic neuro logical deficit is 15-19%. 63,70 Dural arteriovenous fistulas without cortical venous reflux, have a low risk of hemor rhage 14,19 and have been reported to undergo spontaneous regression. 38 In 1972, Houser et al 24 observed the development of DAVFs in patients with previous venous thrombosis docu mented by catheter angiography.…”