Natural History of Dural Arteriovenous Shunts

Abstract

Background and Purpose— Dural arteriovenous shunts with cortical venous reflux or drainage may cause neurological symptoms and death with or without intracranial hemorrhage. Present knowledge about the natural history of these lesions is limited, however. We investigated the incidences of intracranial hemorrhage, progressive dementia syndrome, and death in patients diagnosed in our neurovascular center. Methods— We evaluated the records of 85 patients with dural arteriovenous shunts with cortical venous drainage or reflux hospitalized in our institution from 1978 to 2007. The annual incidences of intracranial hemorrhage, progressive dementia syndrome, and death were calculated. Results— Fifty-three patients did not have an intracranial hemorrhage as the presenting event. One of these patients bled after diagnosis. Thirty-two patients had an intracranial hemorrhage as the presenting event. Three patients bled after diagnosis. One of these patients died. Apart from deficits caused by hemorrhage, no patient reported adverse neurological symptoms. In patients presenting with an intracranial hemorrhage the annual risk for hemorrhage is approximately 7.4% and in those not presenting with a hemorrhage it is approximately 1.5%. Conclusion— The risk of intracranial hemorrhage from a dural arteriovenous shunt with cortical venous drainage is most likely smaller than previously proposed. Presentation with hemorrhage is a risk factor for hemorrhage. The risks of developing neurological symptoms not related to hemorrhage are also less than previously reported.

Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review

“…Söderman et al reported a 1.5% annual risk of hemorrhage in 53 patients with unruptured DAVFs with CVD. 43 In the same study, this risk increased to 7.4% per year for those with ruptured DAVFs. Strom et al reported a similar annual hemorrhage rate of 1.4% in 17 patients harboring DAVFs with CVD without prior hemorrhage.…”

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.…”

“…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. In the cohort of 53 patients who did not present with intracranial hemorrhage, 1 patient bled during a time-at-risk period of 67.1 patient-years, conferring an annual 1.5% risk for intracranial hemorrhage.…”

CT Angiography as a Screening Tool for Dural Arteriovenous Fistula in Patients with Pulsatile Tinnitus: Feasibility and Test Characteristics

“…22,36,37 Awad et al, 34 in an early meta-analysis, found 203 patients with PT-associated DAVF showing a nonaggressive natural history. Controversy exists as to the rate at which low-grade fistulas convert to aggressive phenotypes.…”

“…Controversy exists as to the rate at which low-grade fistulas convert to aggressive phenotypes. 23,37 CTA evaluation of cortical venous reflux in the current study was limited for several reasons. The cohort of patients with PT does not, in general, have high-grade fistulas.…”