“Loop-like formation” in the cortical venous reflux of dural arteriovenous fistula with intracranial hemorrhage

Background: and purpose The annual mortality rate of the patients who had dural arteriovenous fistula (dAVF) with cortical venous reflux (CVR) is high without treatment and early diagnosis is considered desirable. However, diagnostic symptoms of dAVF with CVR are varied and sometimes non specific or chronic one such as tinnitus, headache, dizziness, dementia and so on, which causes of delay in diagnosis. We sought to determine the subcortical calcifications on computed tomography (CT) scans as the diagnostic sign of dAVF with CVR. Material and methods: In 119 consecutive patients diagnosed with dAVF by the cerebral angiographic findings, we reviewed for the prevalence of subcortical calcifications on CT, shunting sites and side of shunting and the presence of cortical venous reflux (CVR) on angiograms and clinical symptoms leading to the diagnosis (diagnostic symptoms). Results: Subcortical calcifications on CT scans were seen in 10 patients (8.4% of 119 patients with dAVF). All of them had dAVF of transverse-sigmoid sinus (TS-dAVF) with CVR. Prevalence of subcortical calcifications was significantly higher in patients with TS-dAVF (P<0.001) (21%, 10 of 48 patients) than in patients with other than TS-dAVF (0 of 71 patients), and significantly higher in patients with CVR (P<0.001) (19 %, 10 of 52 patients) than in patients without CVR (0%, 0 of 67 patients). Subcortical calcifications tended to limited in the posterior part of the same hemisphere as hemisphere with shunting and appeared to be curvilinear ones predominantly involving the cortico-medullary junction at the bottom of cerebral gyri. Prevalence of subcortical calcifications was significantly higher in patients with chronic or non specific symptom (P<0.001, 26 %, 8 of 31 patients) than those with acute or ophthalmic symptom (2%, 2 of 88 patients). Conclusion: Subcortical calcification on CT is a sign of TS-dAVF with CVR, specifically in patients who present chronic or non specific symptoms. Subcortical calcifications found in TS-dAVF could be caused by venous congestion due to long-lasting CVR without being noticed or diagnosed.

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AGGRESSIVE INTRACRANIAL DURAL ARTERIOVENOUS FISTULA PRESENTING WITH CEREBROSPINAL FLUID RHINORRHEA

Neurosurgery ◽

10.1227/01.neu.0000356975.63780.33 ◽

2009 ◽

Vol 65 (6) ◽

pp. E1208-E1209 ◽

Cited By ~ 5

Author(s):

Peter W.A. Willems ◽

Robert A Willinsky ◽

Yoram Segev ◽

Ronit Agid

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Cerebrospinal Fluid Leak ◽

Minor Trauma ◽

Venous Reflux ◽

Increased Intracranial Pressure ◽

Cortical Venous Reflux ◽

Fluid Leak

Abstract OBJECTIVE This is the first report of an aggressive dural arteriovenous fistula presenting with rhinorrhea. It demonstrates the importance of recognizing increased intracranial pressure, and its underlying cause, as the predisposing factor to a spontaneous cerebrospinal fluid leak because this carries implications for management. CLINICAL PRESENTATION Ten years after minor trauma and directly after an intercontinental flight, a 43-year-old woman presented with rhinorrhea. Right-sided pulsatile tinnitus had been present for the past 9 years. Imaging demonstrated an intracranial dural arteriovenous fistula of the right transverse sinus with cortical venous reflux. Magnetic resonance imaging findings indicated long-standing increased intracranial pressure. INTERVENTION The fistula was treated by endovascular means, using both transvenous and transarterial approaches, which led to immediate relief of the tinnitus and resolution of the rhinorrhea within 4 days. CONCLUSION A dural arteriovenous fistula should be included in the differential diagnosis of underlying causes of increased intracranial pressure when examining a patient with a cerebrospinal fluid leak. Treatment of the fistula should precede attempts to treat the rhinorrhea, especially if the fistula has cortical venous reflux.

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Endovascular Treatment of a Dural Arteriovenous Fistula of the Transverse Sinus by Recanalisation, Angioplasty and Stent Deployment

Interventional Neuroradiology ◽

10.1177/159101990300900111 ◽

2003 ◽

Vol 9 (1) ◽

pp. 65-69 ◽

Cited By ~ 5

Author(s):

W. Weber ◽

B. Kis ◽

J. Esser ◽

P. Berlit ◽

D. Kühne

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Clinical Symptoms ◽

Venous Drainage ◽

Venous Hypertension ◽

Venous Reflux ◽

Stent Deployment ◽

Total Occlusion ◽

Cortical Venous Reflux

We report the endovascular treatment of a 40-year-old woman with bilaterally thrombosed transverse sinuses and a dural arteriovenous fistula (DAVF) causing cortical venous reflux by recanalization, angioplasty and stent deployment of the occluded sinus segment followed by occlusion of the DAVF by stent deployment in the fistulous segment. By recanalization of the occluded sinus we re-established normal anterograde venous drainage and eliminated the venous hypertension and cortical venous reflux. After the procedure, the patient was treated with aspirin and clopidogrel for three months. A follow-up examination showed total occlusion of the DAVF, patency of the sinus and a complete resolution of the clinical symptoms.

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Diagnostic accuracy of CTA and MRI/MRA in the evaluation of the cortical venous reflux in the intracranial dural arteriovenous fistula DAVF

Neuroradiology ◽

10.1007/s00234-017-1948-2 ◽

2017 ◽

Vol 60 (1) ◽

pp. 7-15 ◽

Cited By ~ 2

Author(s):

Yen-Heng Lin ◽

Yu-Fen Wang ◽

Hon-Man Liu ◽

Chung-Wei Lee ◽

Ya-Fang Chen ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Venous Reflux ◽

Cortical Venous Reflux

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Reversal of Cortical Venous Reflux in Dural Arteriovenous Fistula with Change in Blood Pressure

Clinical Neuroradiology ◽

10.1007/s00062-018-0737-6 ◽

2018 ◽

Vol 29 (2) ◽

pp. 375-378

Author(s):

Christine A. Meadows ◽

Andrew Carlson ◽

Peter Vorobieff

Keyword(s):

Blood Pressure ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Venous Reflux ◽

Cortical Venous Reflux

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A Case of Spontaneous Acute Subdural Hemorrhage Caused by a Dural Arteriovenous Fistula on the Convexity without Cortical Venous Reflux

Case Reports in Neurology ◽

10.1159/000504290 ◽

2019 ◽

Vol 11 (3) ◽

pp. 312-318 ◽

Cited By ~ 1

Author(s):

Keita Yamauchi ◽

Shunsuke Takenaka ◽

Tomohiro Iida ◽

Hideki Sakai

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Transarterial Embolization ◽

Middle Meningeal Artery ◽

Neurological Deficits ◽

Acute Subdural Hematoma ◽

Subdural Hemorrhage ◽

Venous Reflux ◽

Sagittal Sinus ◽

Cortical Venous Reflux

Bleeding from a dural arteriovenous fistula (DAVF) typically occurs in the form of an intracerebral or subarachnoid hemorrhage. Here, we report a rare case of a DAVF with an acute subdural hematoma (ASDH). A 29-year-old male presented to the emergency department with a complaint of progressing headache and nausea, with no reported episode of head trauma. Non-contrast CT revealed a left ASDH with a moderate midline shift. Digital subtraction angiography revealed a DAVF on the left parietal convexity. The DAVF was fed by the middle meningeal artery and drained into the superior sagittal sinus and the sphenoparietal sinus via the diploic vein without cortical venous reflux. The DAVF was treated with transarterial embolization using 25% diluted n-butyl cyanoacrylate prior to hematoma removal. The bleeding point was confirmed on the inner surface of the dura mater. The patient recovered well without any neurological deficits.

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Updates in the management of cranial dural arteriovenous fistula

Stroke and Vascular Neurology ◽

10.1136/svn-2019-000269 ◽

2019 ◽

Vol 5 (1) ◽

pp. 50-58 ◽

Cited By ~ 2

Author(s):

Humain Baharvahdat ◽

Yinn Cher Ooi ◽

Wi Jin Kim ◽

Ashkan Mowla ◽

Alexander L Coon ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Treatment Approach ◽

Vascular Malformations ◽

Venous Drainage ◽

Neurological Injury ◽

First Line ◽

Venous Flow ◽

Cortical Venous Reflux ◽

Selection Of

Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. While they can be benign lesions, the presence of retrograde venous drainage and cortical venous reflux makes the natural course of these lesions aggressive high risk of haemorrhage, neurological injury and mortality. Endovascular treatment is often the first line of treatment for dAVF. Both transarterial and transvenous approaches are used to cure dAVF. The selection of treatment approach depends on the angioarchitecture of the dAVF, the location, the direction of venous flow. Surgery and, to a lesser extent, stereotactic radiosurgery are used when endovascular approaches are impossible or unsuccessful.

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