Intracranial dural arteriovenous fistulae with perimedullary venous drainage. Anatomical, clinical and therapeutic considerations

Abstract

We report five cases of intracranial dural arteriovenous fistula (DAVF) with perimedullary venous drainage. All the patients presented with rapidly progressive myelopathy and three had autonomic disorders. The DAVF were on the tentorium cerebelli (two cases), sigmoid (one), superior petrosal (one), and cavernous sinus (one). Slow venous drainage was directed through dilated perimedullary cervical veins. The transverse sinus was occluded in two cases. MRI, performed in four cases, demonstrated high signal on T2-weighted spin-echo sequences in the medulla oblongata and upper cervical spinal cord consistent with oedema, which signal resolved after complete cure of the DAVF in three cases. Embolisation was performed in all cases. It was followed by clinical deterioration in two cases and in the dramatic improvement in the other three, with complete clinical cure in two. Extensive venous thrombosis may explain the deterioration observed in one case.

The anterior medullary–anterior pontomesencephalic venous system and its bridging veins communicating to the dural sinuses: normal anatomy and drainage routes from dural arteriovenous fistulas

“…To the best of our knowledge, only one case has been reported for the bridging venous drainage in the English literature [6]. Although we found some additional cases of angiography suggesting bridging venous drainage to the APM-AMV in previously published papers, none showed specific descriptions of the drainage route to the brain stem [4,5,11]. In our review of cases of cavernous dural AVFs, we demonstrated a high incidence of cases of bridging venous drainage into the APM-AMV system (seven of 40 cases).…”

“…All four cases of dural AVFs presented with subsrachnoid hemorrhage, and the AVFs drained ascending into the cavernous sinus, the superior petrosal sinus, or the inferior petrosal sinus. Several cases of intracranial dural AVFs draining into the APM-AMV system have been reported, and the majority of the reported cases showed brain stem injury due to venous congestion and/or hemorrhage [3][4][5][6]. Two potential drainage routes to the APM-AMV system of the petrosal venous route and the bridging venous routes exist.…”

“…This longitudinal venous channel communicates with the adjacent dural sinuses via the transverse pontine vein and/or bridging veins [2]. Therefore, dural arteriovenous fistulas (DAVFs) can drain through bridging veins into the APM-AMV system and may cause serious symptoms such as pontine hemorrhage and venous edema [3][4][5][6]. However, little attention has been paid to the venous anatomy of the bridging veins and the APM-AMV system.…”

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

“…Bulbar dysfunction was reported in seven cases. 22) The neurological symptoms of our patient were most likely related to spinal cord dysfunction (bowel and bladder dysfunction and paraparesis) as well as brainstem signs such as unconsciousness and dyspnea. The symptoms of our patient are similar to those of previously reported cases of intracranial dAVFs, in which the patients presented with myelopathy first and brainstem symptoms appeared later.…”

“…[2][3][4][6][7][8]10,[15][16][17][19][20][21][22][23][24][25][26][27][28][29][30] The most common symptom is ascending myelopathy, starting as loss of sensation and motor function in the lower extremities and extending to the upper extremities. Sphincter function is impaired.…”