Image Diagnosis: Encephalopathy Resulting from Dural Arteriovenous Fistula

Santos, Ana Filipa; Machado, Catarina; Varanda, Sara; Pinho, João; Ribeiro, Manuel; Rocha, Jaime; Maré, Ricardo

doi:10.7812/tpp/15-218

TPJ

2016

DOI: 10.7812/tpp/15-218

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Image Diagnosis: Encephalopathy Resulting from Dural Arteriovenous Fistula

Ana Filipa Santos

Catarina Machado

Sara Varanda

et al.

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2021

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“…In clinical practice, cases are seen in which symptoms apparently result from an association between the patient's DAVF and insufficiency of the patient's venous system. 20,28,29 In the literature, studies on this topic have been limited to review of the venous drainage of DAVF, and we did not find any papers evaluating the association between unfavorable venous configuration at the time of clinical presentation and the incidence of severe symptoms.…”

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Cerebral venous drainage in patients with dural arteriovenous fistulas: correlation with clinical presentation

Neto

Costa

Pinheiro

et al. 2021

Journal of Neurosurgery

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OBJECTIVEDural arteriovenous fistulas (DAVFs) are abnormal, acquired arteriovenous connections within the dural leaflets. Their associated symptoms may be mild or severe and are related to the patient’s venous anatomy. With the hypothesis that the patient’s venous anatomy determines the development of symptoms, the authors aimed to identify which venous anatomy elements are important in the development of major symptoms in patients with a DAVF.METHODSA multicenter study was performed based on the retrospective analysis of cerebral angiographies with systematic assessment of brain drainage pathways (including fistula drainage) in patients over 18 years of age with a single DAVF. The patients were divided into two groups: those with minor (group 1, n = 112) and those with major (group 2, n = 89) symptoms. Group 2 was subdivided into two groups: patients with hemorrhage (group 2a, n = 47) and patients with severe nonhemorrhagic symptoms (group 2b, n = 42).RESULTSThe prevalence of stenosis in DAVF venous drainage and the identification of tiny anastomoses between venous territories were significantly higher in group 2 (32.6% and 19.1%, respectively) compared with group 1 (2.68% and 5.36%, respectively). Stenosis of DAVF venous drainage was significantly more frequent in group 2a than in group 2b (51.1% vs 11.9%, p < 0.001). Group 2b patients had increased prevalence of shared use of the cerebral main drainage pathway (85.0% vs 53.2%, p = 0.002), the absence of an alternative route (45.0% vs 17.0%, p = 0.004), and the presence of contrast stagnation (62.5% vs 29.8%, p = 0.002) compared with group 2a patients. In patients with high-grade fistulas, the group with major symptoms had increased prevalence of a single draining direction (31.3% vs 8.33%, p = 0.003), stenosis in the draining vein (35.0% vs 6.25%, p = 0.000), the absence of an alternative pathway for brain drainage (31.3% vs 12.5%, p = 0.017), and the presence of contrast stagnation (48.8% vs 22.9%, p = 0.004).CONCLUSIONSMajor symptoms were observed when normal brain tissue venous drainage was impaired by competition with DAVF (predominance in group 2b) or when DAVF venous drainage had anatomical characteristics that hindered drainage, with consequent venous hypertension on the venous side of the DAVF (predominance in group 2a). The same findings were observed when comparing two groups of patients with high-grade lesions: those with major versus those with minor symptoms.

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confidence: 95%

Cerebral venous drainage in patients with dural arteriovenous fistulas: correlation with clinical presentation

Neto

Costa

Pinheiro

et al. 2021

Journal of Neurosurgery

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Image Diagnosis: Encephalopathy Resulting from Dural Arteriovenous Fistula

Cited by 1 publication

References 4 publications

Cerebral venous drainage in patients with dural arteriovenous fistulas: correlation with clinical presentation

Cerebral venous drainage in patients with dural arteriovenous fistulas: correlation with clinical presentation

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