Intracranial Dural Arteriovenous Fistulas: Analysis of 60 Patients

Abstract

Objective: To analyze and update the clinical symptomatology, CT and MRI findings, angiographic features, and therapeutic outcomes of patients with dural arteriovenous fistulas (DAVFs). Background: Studies of DAVFs in a large number of patients have seldom appeared in neurology literature. Methods: The authors investigated 60 consecutive patients with DAVFs who were admitted between January 1991 and January 2001. The DAVFs were graded into five types according to the classification of Cognard et al. [Radiology 1995;194:671–680]. Presumable etiologies, clinical features, imaging findings and therapeutic outcomes were evaluated on the basis of the location and type of DAVFs. Results: Sinus thrombosis, previous trauma, craniotomy, cerebral infarction and acupuncture were detected as possible etiologic factors of DAVFs. The cavernous sinus (57%) was the most common location of DAVFs. Although the neurological symptoms were closely related to the location of the DAVFs, in some patients, there were also symptoms that did not reflect the location. Although the women outnumbered the men, the men presented with aggressive neurological manifestations more often (p < 0.05). Ten out of 12 patients (83%) with DAVFs involving locations other than the large sinuses presented with aggressive neurological manifestations. 70% of brain CTs and 81% of brain MRIs showed abnormal findings suggestive of DAVFs. Of 33 patients who underwent only endovascular embolization, 29 patients (88%) were cured or improved. Radiosurgery and surgical excision done in some patients provided fair results. Patients with DAVFs involving large sinuses showed a better therapeutic outcome than those in whom locations other than the large sinuses were involved, while patients without venous ectasia had more a favorable outcome than those with it (each, p < 0.01). Conclusions: DAVFs result from various etiologic factors, show diverse manifestations usually reflecting the location and can be treated successfully in most patients. Factors related to poor clinical outcome include male sex, the presence of venous ectasia and involved locations other than the large sinuses.

Cerebral Venous Thrombosis: Diagnostic Accuracy of Combined, Dynamic and Static, Contrast-Enhanced 4D MR Venography

“…12,23 This may lead to false diagnosis, as the latter entity frequently occurs as a sequela of chronic CVT and is clinically initially often undiagnosed. 24 Therefore, the adjunct of a dynamic MR angiographic sequence, as in combo-4D MRV, may be of added value, as it also enables the diagnosis of arteriovenous shunts with high confidence. [13][14][15]17 However, the clinically very important differentiation between both entities requires further research, as this was not the focus of our present study.…”

Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms

“…DAVFs occur in the transverse, sigmoid, and cavernous sinuses and most of them present in adulthood 2,3 .…”

Connection Between a Dural Artery and a Dural Vein in a Dural Arteriovenous Fistula of the Cranial Vault-Case Report-

“…Various hypotheses, including trauma, 2,7) surgery, 10,13) and dural sinus thrombosis, 1,6) have been presented, but the etiology has never been fully explained. Dural AVFs are now thought to be acquired lesions 1,3,6) caused by events such as head injury, craniotomy, or sinus thrombosis triggering the opening of physiological dural arteriovenous connections 8,12) and resulting in the formation of a dural AVF.…”