Long-term changes in intracranial dural arteriovenous fistulae leading to worsening in the type of venous drainage

1997 ◽  
Vol 39 (1) ◽  
pp. 59-66 ◽  
Author(s):  
C. Cognard ◽  
E. Houdart ◽  
A. Casasco ◽  
J. Gabrillargues ◽  
J. Chiras ◽  
...  
Keyword(s):  
Venous Drainage ◽  
Arteriovenous Fistulae ◽  
Long Term Changes ◽  
Intracranial Dural Arteriovenous Fistulae

Surgical Treatment of Intracranial Dural Arteriovenous Fistulae: Role of Venous Drainage

Neurosurgery ◽  
2000 ◽  
Vol 47 (1) ◽  
pp. 56-67 ◽  
Author(s):  
Massimo Collice ◽  
Giuseppe D'Aliberti ◽  
Orazio Arena ◽  
Consuelo Solaini ◽  
Romero A. Fontana ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Venous Drainage ◽  
Arteriovenous Fistulae ◽  
Intracranial Dural Arteriovenous Fistulae

The Natural History and Management of Intracranial Dural Arteriovenous Fistulae

1997 ◽  
Vol 3 (4) ◽  
pp. 303-311 ◽  
Author(s):  
M.A. Davies ◽  
K. ter Brugge ◽  
R. Willinsky ◽  
M.C. Wallace
Keyword(s):  
Natural History ◽  
Venous Drainage ◽  
Treated Group ◽  
Adverse Outcomes ◽  
Arteriovenous Fistulae ◽  
Surgical Access ◽  
History Of ◽  
Grade Ii ◽  
Intracranial Dural Arteriovenous Fistulae

The natural history of aggressive intracranial dural arteriovenous fistulae (ICDAVF) is unknown. Despite this, the recently proposed classification scheme of Borden et al (Borden*) has the potential to predict aggressive lesion behavior after presentation for any lesion, but has so far been untested. In addition, they discuss a new but logical treatment strategy for aggressive ICDAVF based on the elimination of retrograde leptomeningeal venous drainage (RLVD). Our similar philosophy and substantial experience with these lesions, provides a unique opportunity to test these hypotheses. A cohort of 46 Borden* grade II and III ICDAVF was selected from a series of 102 ICDAVF seen at a single institution between 1984 and 1995. Patients with these lesions, presumed to have an aggressive course were all offered treatment. Conservative therapy was chosen by 14 (30%) patients, 22 (47%) had surgery, and 20 (43%) had embolisation either as sole treatment or prior to surgery. During the follow-up period (249 lesion months) for the conservatively treated group, four (29%) patients died. Excluding presentation, these patients were observed to have interval rates of intracranial hemorrhage (ICH), non haemorrhagic neurological deficit (NHND), and mortality, of 19.2%, 10.9%, and 19.3% / lesion year respectively. The 11 patients who had embolisation alone were followed for a total of 344 months after treatment. All nine patients who had lesion obliteration, or subtotal obliteration with elimination of RLVD, as confirmed by angiography, experienced improvement or complete clinical recovery. Two patients had subtotal obliteration without elimination of RLVD. One died from interval ICH and the other experienced a delayed NHND. Twenty-five surgical operations were performed on 23 ICDAVF in 22 patients. Resection of the ICDAVF was performed in 9 patients, and 16 patients were treated with surgical disconnection alone. Complications occurred in 3/9 (33%) patients who had their lesions resected and none of the disconnected group. Failure to achieve angiographic obliteration of RLVD in 2 patients treated with resection was associated with an adverse outcome in both cases (death, and interval NHND). All 16 (100%) of the disconnected group were shown to have undergone angiographic obliteration with excellent clinical outcome. Untreated, Borden* grade II and III ICDAVF have a poor natural history. Also, persistence of RLVD after inadequate treatment results in adverse outcomes. Embolisation usually improves the safety of surgical access and may lead to obliteration on its own in some cases. For the aggressive ICDAVF, surgery is required in most cases, and our data confirm that surgical disconnection alone results in cure of all Borden* grade III ICDAVF, and in grade II lesions, if not cure, conversion to a benign grade I lesion.

The Natural History and Management of Intracranial Dural Arteriovenous Fistulae

1997 ◽  
Vol 3 (4) ◽  
pp. 295-302 ◽  
Author(s):  
M.A. Davies ◽  
J. Saleh ◽  
K. ter Brugge ◽  
R. Willinsky ◽  
M.C. Wallace
Keyword(s):  
Natural History ◽  
Predictive Ability ◽  
Venous Drainage ◽  
Middle Cranial Fossa ◽  
Foramen Magnum ◽  
Symptom Improvement ◽  
Arteriovenous Fistulae ◽  
History Of ◽  
Intracranial Dural Arteriovenous Fistulae

The recently proposed classification scheme of Borden, Wu, and Shucart (Borden*) should have the ability to identify those intracranial dural arteriovenous fistulae (ICDAVF) which will continue to behave in a benign fashion. We examine for the first time the natural history of benign ICDAVF, including the predictive ability of this grading scale, and the implications for lesion management. A cohort of 55 Borden* grade I lesions was selected from a heterogeneous series of 102 consecutive ICDAVF seen at one institution between 1984 and 1995. Data were collected prospectively from 1991. Grade I lesions were those whose nidus drained directly into a dural venous sinus (DVS) or meningeal vein. The absence of retrograde leptomeningeal venous drainage (RLVD) was an important feature. Intracranial haemorrhage (ICH), non haemorrhagic neurological deficit (NHND), and death were considered aggressive features. There were 23 cavernous sinus, 2 foramen magnum, 1 middle cranial fossa, and 29 transverse sinus lesions. One patient received obliterative surgical treatment. Thirty-two lesions were observed only, and 22 patients developed symptoms or signs requiring palliative embolisation. Two minor complications occurred following embolisation: transient pulmonary aedema (1), and an asymptomatic pericallosal artery embolus (1). Follow-up was available on 48 (89%) patients for a total of 133 patient years (mean 33 months). This included 26 of the 32 patients observed and all 22 of the patients embolised. Aggressive interval behavior was seen in only one patient. Symptom improvement or resolution was observed in the majority of patients, whether observed only [21/26 (81%)], or whether they required embolisation for symptom palliation [19/22 (86%)]. Overall, 53 of the 54 (98%) of ICDAVF behaved in a benign fashion in the follow-up period. The predictable benign natural history of patients identified as Borden* grade I at presentation mandates a conservative approach to these ICDAVF. In some patients, when symptom severity demands, palliative embolisation is an effective and safe therapy.

Surgical Treatment of Intracranial Dural Arteriovenous Fistulae: Role of Venous Drainage

Neurosurgery ◽  
2000 ◽  
Vol 47 (1) ◽  
pp. 56-67 ◽  
Author(s):  
Massimo Collice ◽  
Giuseppe D’Aliberti ◽  
Orazio Arena ◽  
Consuelo Solaini ◽  
Romero A. Fontana ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Venous Drainage ◽  
Arteriovenous Fistulae ◽  
Intracranial Dural Arteriovenous Fistulae

RISK FACTORS FOR HEMORRHAGIC PRESENTATION IN PATIENTS WITH DURAL ARTERIOVENOUS FISTULAE

Neurosurgery ◽  
2008 ◽  
Vol 62 (3) ◽  
pp. 628-635 ◽  
Author(s):  
Vineeta Singh ◽  
W. S. Smith ◽  
Michael T. Lawton ◽  
Van V. Halbach ◽  
William L. Young
Keyword(s):  
San Francisco ◽  
Posterior Fossa ◽  
Intracranial Hemorrhage ◽  
Multivariate Logistic Regression Analysis ◽  
Venous Drainage ◽  
Neurological Deficits ◽  
Arteriovenous Fistulae ◽  
Cortical Venous Drainage ◽  
Intracranial Dural Arteriovenous Fistulae ◽  
Independent Effects

Abstract OBJECTIVE Intracranial dural arteriovenous fistulae (DAVFs) can present as disabling intracranial hemorrhage. The aim of this study was to investigate the independent effects of specific demographic and clinical variables on hemorrhagic presentation in patients with DAVFs. METHODS All patients with DAVFs evaluated at the University of California at San Francisco from July 1988 through June 2004 were identified. Clinical and radiographic characteristics were recorded using a detailed abstraction form. RESULTS A total of 402 patients with DAVFs were identified, 73 (18%) of whom presented with intracranial hemorrhage. Men were twice as likely to present with hemorrhage (men 70% versus women 30%, P < 0.001). Cortical venous drainage (85 versus 22%; P < 0.001), retrograde venous drainage (59 versus 36%; P < 0.001), and sinus occlusion (33 versus 18%; P = 0.004) were also more common in patients with DAVF with hemorrhagic presentation. In multivariate logistic regression analysis, cortical venous drainage (odds ratio [OR], 10.5; P < 0.001), focal neurological deficits (OR, 4.7; P < 0.001), DAVFs in the posterior fossa (OR, 4.0; P = 0.005), male sex (OR, 3.4, P = 0.001), and age older than 50 years were found to be independently associated with hemorrhagic presentation. CONCLUSION Although DAVFs are less frequent in men than in women, they are more likely to present with hemorrhage. In addition to cortical venous drainage, a well-known risk factor for intracranial hemorrhage, posterior fossa location, older age at presentation, and focal neurological deficits were independently associated with hemorrhagic presentation in patients with DAVFs.

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