Dural Arteriovenous Fistulas with Venous Drainage Patterns Inducing Ocular Manifestations Mimicking a Carotid Cavernous Fistula: Report of 2 Cases

A cerebral dural arteriovenous fistula (DAVF) is an acquired abnormal arterial-to-venous connection within the leaves of the intracranial dura with a wide range of clinical presentations and natural history. The Cognard classification correlates venous drainage patterns with neurological course, identifying 5 DAVF types with increasing rates of symptomatic presentation. A spinal DAVF occurs when a radicular artery makes a direct anomalous shunt with a radicular vein within the dural leaflets of the nerve root sleeve. A cervical DAVF is a rare entity, as most spinal DAVFs present as thoracolumbar lesions with myelopathy. In this paper the authors present 2 patients presenting initially with brainstem dysfunction rather than myelopathy secondary to craniocervical DAVF. The literature is then reviewed for similar rare aggressive DAVFs at the craniocervical junction presenting with brainstem symptomatology.

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Spontaneous carotid-cavernous fistula during pregnancy or in the postpartum stage

Journal of Neurosurgery ◽

10.3171/jns.1981.54.2.0252 ◽

1981 ◽

Vol 54 (2) ◽

pp. 252-256 ◽

Cited By ~ 38

Author(s):

Shigeo Toya ◽

Ryuzoh Shiobara ◽

Jiroh Izumi ◽

Youichi Shinomiya ◽

Hayao Shiga ◽

...

Keyword(s):

Cerebral Angiography ◽

Clinical Symptoms ◽

Carotid Cavernous Fistula ◽

Normal Delivery ◽

Content Type ◽

Cavernous Fistula ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Spontaneous Improvement ◽

Angiographic Findings

✓ The authors report two cases of spontaneous carotid-cavernous fistula that occurred during pregnancy. One patient was a 21-year-old woman whose symptoms improved and in whom disappearance of the carotid-cavernous fistula was confirmed by cerebral angiography after she aborted in the 12th week of pregnancy. The other patient was a 25-year-old woman in whom a carotid-cavernous fistula occurred at about the 28th week of pregnancy. The symptoms became aggravated 3 weeks after a normal delivery. Carotid-cavernous fistula was confirmed by cerebral angiography, and the clinical symptoms then improved. On the basis of cerebral angiographic findings, both patients were considered to have dural arteriovenous fistulas in the region of the cavernous sinus and both demonstrated spontaneous improvement.

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Advances in Surgical Approaches to Dural Fistulas

Neurosurgery ◽

10.1227/neu.0000000000000228 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S32-S41 ◽

Cited By ~ 19

Author(s):

Patrick P. Youssef ◽

Albert Jess Schuette ◽

C. Michael Cawley ◽

Daniel L. Barrow

Keyword(s):

Treatment Options ◽

Venous Drainage ◽

Venous Hypertension ◽

Surgical Approaches ◽

Dural Sinus ◽

Intraoperative Angiography ◽

Indocyanine Green Videoangiography ◽

Arteriovenous Fistulas ◽

The Past ◽

Dural Arteriovenous Fistulas

Abstract Dural arteriovenous fistulas are abnormal connections of dural arteries to dural veins or venous sinuses originating from within the dural leaflets. They are usually located near or within the wall of a dural venous sinus that is frequently obstructed or stenosed. The dural fistula sac is contained within the dural leaflets, and drainage can be via a dural sinus or retrograde through cortical veins (leptomeningeal drainage). Dural arteriovenous fistulas can occur at any dural sinus but are found most frequently at the cavernous or transverse sinus. Leptomeningeal venous drainage can lead to venous hypertension and intracranial hemorrhage. The various treatment options include transarterial and transvenous embolization, stereotactic radiosurgery, and open surgery. Although many of the advances in dural arteriovenous fistula treatment have occurred in the endovascular arena, open microsurgical advances in the past decade have primarily been in the tools available to the surgeon. Improvements in microsurgical and skull base approaches have allowed surgeons to approach and obliterate fistulas with little or no retraction of the brain. Image-guided systems have also allowed better localization and more efficient approaches. A better understanding of the need to simply obliterate the venous drainage at the site of the fistula has eliminated the riskier resections of the past. Finally, the use of intraoperative angiography or indocyanine green videoangiography confirms the complete disconnection of fistula while the patient is still on the operating room table, preventing reoperation for residual fistulas.

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Study of Dural Arteriovenous Fistula Drains into Leptomeningeal Vein without Sinus Interposition

Interventional Neuroradiology ◽

10.1177/15910199040100s122 ◽

2004 ◽

Vol 10 (1_suppl) ◽

pp. 127-134 ◽

Cited By ~ 6

Author(s):

T. Kawaguchi ◽

M. Nakatani ◽

T. Kawano

Keyword(s):

Emergency Treatment ◽

Superior Sagittal Sinus ◽

Venous Drainage ◽

Craniocervical Junction ◽

Sigmoid Sinus ◽

Arteriovenous Fistulas ◽

Sagittal Sinus ◽

Dural Arteriovenous Fistulas ◽

Cranial Fossa ◽

Venous Ischemia

We evaluated dural arteriovenous fistulas (DAVF) drains into leptomeningeal vein (LMV) without the venous sinus interposition. This type of DAVF contained the extra-sinusal type DAVF and the DAVF with so-called pure leptomeningeal venous drainage (PLMVD). We studied 15 patients with DAVF that flows into LMVD without passing into the sinus. The subjects were 5 patients with DAVF in the anterior cranial fossa, 2 with DAVF in the tentorium cerebelli, and 3 with DAVF in the craniocervical junction as extra-sinusal type DAVF and 3 with DAVF in the transverse sigmoid sinus and 2 with DAVF in the superior sagittal sinus as DAVF with PLMVD. This type appears to take a very aggressive course. The arterial pressure of the shunt is directly applied to LMV, which causes bending and winding of the vein, eventually varices, inducing intracranial haemorrhage or venous ischemia in the LMV reflux area. Emergency treatment should be performed as soon as possible. Although it is recognized that interruption of the draining vein is very effective, treatment methods such as TAE, direct surgery, and g knife treatment, or their combinations should be carefully chosen for each case.

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Embolization of a superior sagittal sinus dural arteriovenous fistula under intrasinus balloon protection: A case report

Interventional Neuroradiology ◽

10.15274/inr-2014-10098 ◽

2015 ◽

Vol 21 (1) ◽

pp. 94-100 ◽

Cited By ~ 8

Author(s):

Yongxin Zhang ◽

Qiang Li ◽

Qing-hai Huang

Keyword(s):

Dural Arteriovenous Fistula ◽

Superior Sagittal Sinus ◽

Therapeutic Option ◽

Venous Drainage ◽

Endovascular Embolization ◽

Arteriovenous Fistulas ◽

Sagittal Sinus ◽

Dural Arteriovenous Fistulas ◽

Cerebral Venous Drainage ◽

Balloon Protection

Endovascular embolization has evolved to become the primary therapeutic option for dural arteriovenous fistulas (DAVFs). While guaranteeing complete occlusion of the fistula orifice, the goal of DAVF embolization is also to ensure the patency of normal cerebral venous drainage. This paper describes a case of successful embolization of a complex DAVF in the superior sagittal sinus with a multistaged approach using a combination of transvenous and transarterial tactics. The strategies and techniques are discussed.

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Multiple Dural Arteriovenous Fistulas

Interventional Neuroradiology ◽

10.1177/159101990200800210 ◽

2002 ◽

Vol 8 (2) ◽

pp. 183-191 ◽

Cited By ~ 4

Author(s):

A.J.P. Goddard ◽

M.S. Khangure

Keyword(s):

De Novo ◽

Disease Process ◽

Venous Drainage ◽

Transverse Sinus ◽

Dural Sinus ◽

External Carotid ◽

Unique Case ◽

Arteriovenous Fistulas ◽

Type Iv ◽

Dural Arteriovenous Fistulas

Dural arteriovenous fistulas are most probably acquired lesions. However, they have been rarely encountered de novo. We present a unique case of a 71-year-old woman who initially presented with right-sided dural arteriovenous fistula (DAVF), which spontaneously resolved after diagnostic arteriography. She later developed asymptomatic occlusion of the left transverse sinus. Five years after her initial presentation she developed left-sided pulse-synchronous tinnitus. MRA and catheter angiography showed a complex type IV DAVF between the left transverse sinus and multiple dural branches arising from both left and right external carotid arteries. The left transverse sinus was isolated from the torcula herophili, with stenosis of the sigmoid sinus. Extensive cortical venous drainage was demonstrated. Endovascular cure was effected by polyvinyl alcohol particle and absolute alcohol occlusion of the dominant dural supply, and transvenous coil occlusion of the left transverse sinus. The patient's symptoms resolved almost immediately. This unique case demonstrates that dural sinus occlusion and DAVFs may co-exist, but there may not be a causal relationship. It is likely that both DAVFs and sinus occlusion are manifestations of the same disease process characterised by a pro-thrombotic state and secondary angiogenesis. It is important to recognise that changes in symptomatology, even long after apparent disappearance of a lesion may indicate recurrence, and careful follow up is advocated.

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Venous Drainage Patterns in Carotid Cavernous Fistulas

ISRN Radiology ◽

10.1155/2014/760267 ◽

2014 ◽

Vol 2014 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Ayse Aralasmak ◽

Kamil Karaali ◽

Can Cevikol ◽

Utku Senol ◽

Timur Sindel ◽

...

Keyword(s):

Treatment Approach ◽

Imaging Techniques ◽

Venous Drainage ◽

High Flow ◽

Digital Subtraction ◽

Carotid Cavernous Fistula ◽

Drainage Patterns ◽

Carotid Cavernous Fistulas ◽

Mixed Types ◽

Anterior Posterior

Purpose. The carotid-cavernous fistula (CCF) is an abnormal arteriovenous communication and its drainage pathways may affect the clinic presentation and change treatment approach. We evaluated drainage patterns of CCFs by digital subtraction angiography (DSA) and categorized drainage pathways according to their types and etiology. Materials and Methods. Venous drainage patterns of 13 CCFs from 10 subjects were studied and categorized as anterior, posterior, superior, inferior, and contralateral on DSA. Drainage patterns were correlated to types and etiology of CCFs. Diagnosis of CCFs was first made by noninvasive imaging techniques. Results. On DSA, traumatic CCFs were usually high flow, direct type while spontaneous CCFs were usually slow flow, indirect type. Bilaterality and mixed types were observed among the indirect spontaneous CCFs. In all CCFs, anterior and inferior drainages were the most common. Contrary to the literature, posterior and superior drainages were noted only in high flow and long standing direct fistulas. Contralateral drainage was not observed in all, supporting plausible compartmentalization of cavernous sinuses. Conclusion. Types, etiology, and duration of the CCFs may affect their drainage patterns. DSA is valuable for categorization of CCFs and verification of drainage patterns. Drainage pathways may affect the clinic presentation and also change treatment approach.

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Posterior Fossa Dural Arteriovenous Fistulas with Subarachnoid Venous Drainage: Outcomes of Endovascular Treatment

American Journal of Neuroradiology ◽

10.3174/ajnr.a6140 ◽

2019 ◽

Vol 40 (8) ◽

pp. 1363-1368 ◽

Cited By ~ 1

Author(s):

L. Détraz ◽

K. Orlov ◽

V. Berestov ◽

V. Borodetsky ◽

A. Rouchaud ◽

...

Keyword(s):

Endovascular Treatment ◽

Posterior Fossa ◽

Venous Drainage ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas

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E-031 Dural arteriovenous fistulas without cortical venous drainage: presentation, treatment and outcomes

10.1136/neurintsurg-2020-snis.67 ◽

2020 ◽

Author(s):

E Samaniego ◽

J Roa ◽

M Hayakawa ◽

S Ortega-Gutierrez ◽

R Guniganti ◽

...

Keyword(s):

Venous Drainage ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Cortical Venous Drainage

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Transylvian Clip Occlusion of an Enlarging High-Flow Tentorial Arteriovenous Fistula: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz344 ◽

2019 ◽

Vol 19 (2) ◽

pp. E172-E173 ◽

Cited By ~ 1

Author(s):

Salomon Cohen-Cohen ◽

Michael J Link ◽

Leonardo Rangel-Castilla

Keyword(s):

Indocyanine Green Angiography ◽

Venous Drainage ◽

Transverse Sinus ◽

Primary Treatment ◽

High Flow ◽

Arteriovenous Fistulas ◽

Surgical Access ◽

Dural Arteriovenous Fistulas ◽

Clip Occlusion ◽

Neurologically Intact

Abstract Endovascular therapy is the primary treatment for the majority of tentorial dural arteriovenous fistulas (dAVF). Surgical occlusion is an effective alternative when embolization is not possible. This video demonstrates microsugical occlusion of a right-sided tentorial dAVF in a symptomatic 45-yr-old male. The dAVF was fed directly by meningohypophyseal trunk. Venous drainage was retrograde through the sphenoparietal sinus, superficial sylvian vein, vein of Labee, and transverse sinus. The patient underwent a right-sided pterional craniotomy; the sylvian fissure was widely opened. Subarachoid dissection was performed until a large arterialized draining vein was identified exiting dura subtemporally. Intraoperative indocyanine green angiography confirmed the fistulous site and the draining vein was occluded and divided. The patient remained neurologically intact after surgery. Immediate angiography demonstrates complete occlusion of the dAVF. This video demonstrates the surgical access obtained through a transylvian approach for this tentorial dAVF. Occlusion of the draining vein, with or without resection of the fistula, is enough to permanently treat these lesions.

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