Pretreatment and Posttreatment Evaluation of Hemodynamic and Metabolic Parameters in Intracranial Dural Arteriovenous Fistulae with Cortical Venous Reflux….Satoshi Kuroda, M.D., Koji Furukawa, M.D., Tohru Shiga, M.D., Satoshi Ushikoshi, M.D., Chietsugu Katoh, M.D., Takeshi Aoki, M.D., Tatsuya Ishikawa, M.D., Kiyohiro Houkin, M.D., Nagayoshi Tamaki, M.D., Yoshinobu Iwasaki, M.D.

Abstract BACKGROUND: The quoted risk of hemorrhage from dural arteriovenous fistulae with cortical venous reflux varies widely, and the influence of angiographic grade on clinical course has not previously been reported. OBJECTIVE: To assess the risk of hemorrhage and the influence of angiographic grade on this risk, compared with known predictors of hemorrhage such as presentation. METHODS: Seventy-five fistulae with cortical venous reflux identified in our arteriovenous malformations clinic between 1992 and 2007 were followed up clinically, and their angiograms were reviewed. RESULTS: There were 8 hemorrhages in 90 years of follow-up. The annual incidence of hemorrhage before any treatment was 13%, and 4.7% after partial treatment, giving an overall incidence of 8.9% before definitive treatment. Borden and Cognard grades were poor discriminators of risk for lesions with the exception of Cognard type IV lesions. These lesions, characterized by venous ectasia, had a 7-fold increase in the incidence of hemorrhage (3.5% no ectasia vs 27% with ectasia). Patients presenting with hemorrhage (20%) or nonhemorrhagic neurological deficit (22%) had a higher incidence of hemorrhage than those with a benign presentation (4.3%), but this may be directly linked to the presence of venous ectasia. CONCLUSION: In this series untreated dural arteriovenous fistulae with cortical venous reflux had a 13% annual incidence of hemorrhage after diagnosis. There was a significant difference between those with and without venous ectasia. This should be confirmed by further studies, but probably defines a high-risk subgroup of patients that requires rapid intervention.

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Pretreatment and Posttreatment Evaluation of Hemodynamic and Metabolic Parameters in Intracranial Dural Arteriovenous Fistulae with Cortical Venous Reflux

Neurosurgery ◽

10.1227/01.neu.0000108863.30871.fd ◽

2004 ◽

Vol 54 (3) ◽

pp. 585-592 ◽

Cited By ~ 17

Author(s):

Satoshi Kuroda ◽

Koji Furukawa ◽

Tohru Shiga ◽

Satoshi Ushikoshi ◽

Chietsugu Katoh ◽

...

Keyword(s):

Metabolic Rate ◽

Dural Arteriovenous Fistula ◽

Emission Tomography ◽

Regional Cerebral Blood ◽

Venous Reflux ◽

Arteriovenous Fistulae ◽

Cerebral Metabolic Rate ◽

Positron Emission ◽

Metabolic Conditions ◽

Cortical Venous Reflux

Abstract OBJECTIVE Retrograde drainage into the cortical veins results in poor outcome in patients with an intracranial dural arteriovenous fistula. However, the pathophysiological features of dural arteriovenous fistulae remain obscure. This study aimed to clarify hemodynamic and metabolic conditions in these patients using positron emission tomography. METHODS This study included eight patients with an intracranial dural arteriovenous fistula. All patients had cortical venous reflux, as demonstrated by angiography. Regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), regional cerebral metabolic rate for oxygen, and regional oxygen extraction fraction (rOEF) were measured before and after surgical or endovascular treatment using positron emission tomography. RESULTS Pretreatment positron emission tomographic studies revealed that all patients had abnormal hemodynamic and metabolic parameters in the area that was drained by the involved cortical veins. A severe increase in rCBV was noted in seven of the eight patients. A significant decrease in rCBF also was observed in all eight patients. A negative correlation was observed between rCBF and rCBV. Three patients had an elevated rOEF. Oxygen metabolism was impaired in seven patients. All patients underwent successful treatment. Follow-up studies demonstrated significant improvements in rCBF, rCBV, and regional cerebral metabolic rate for oxygen. The improvement in regional cerebral metabolic rate for oxygen varied among the patients. Normalization of rOEF also was confirmed in three patients who had increased rOEF before the treatment. CONCLUSION The present results suggest that hemodynamic and metabolic characteristics vary widely among patients with cortical venous reflux. It is essential to precisely evaluate hemodynamic and metabolic conditions to predict their outcomes and therapeutic effects.

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CT and MR imaging of non-cavernous cranial dural arteriovenous fistulas: Findings associated with cortical venous reflux

European Journal of Radiology ◽

10.1016/j.ejrad.2015.04.019 ◽

2015 ◽

Vol 84 (8) ◽

pp. 1555-1563 ◽

Cited By ~ 6

Author(s):

Laurent Letourneau-Guillon ◽

Juan Pablo Cruz ◽

Timo Krings

Keyword(s):

Mr Imaging ◽

Venous Reflux ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas ◽

Cortical Venous Reflux

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

Neurosurgery ◽

10.1097/00006123-200007000-00012 ◽

2000 ◽

Vol 47 (1) ◽

pp. 56-67 ◽

Cited By ~ 14

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

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Transarterial embolization with ONYX for treatment of intracranial non-cavernous dural arteriovenous fistula with or without cortical venous reflux

Journal of NeuroInterventional Surgery ◽

10.1136/jnis.2010.004119 ◽

2011 ◽

Vol 3 (3) ◽

pp. 224-228 ◽

Cited By ~ 26

Author(s):

K. De Keukeleire ◽

P. Vanlangenhove ◽

J.-P. Kalala Okito ◽

G. Hallaert ◽

D. Van Roost ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Transarterial Embolization ◽

Venous Reflux ◽

Cortical Venous Reflux

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Indocyanine Green Videoangiography “In Negative”: Definition and Usefulness in Intracranial Dural Arteriovenous Fistulae

Operative Neurosurgery ◽

10.1227/neu.0b013e318282ddd6 ◽

2013 ◽

Vol 73 (suppl_1) ◽

pp. ons86-ons92 ◽

Cited By ~ 1

Author(s):

Juan Antonio Julián ◽

Pablo Miranda Lloret ◽

Fernando Aparici Robles ◽

Andrés Beltrán Giner ◽

Carlos Botella Asunción

Keyword(s):

Indocyanine Green ◽

Arteriovenous Fistula ◽

Arteriovenous Malformations ◽

Dural Arteriovenous Fistula ◽

Simple Procedure ◽

Vascular Pathology ◽

Digital Subtraction ◽

Indocyanine Green Videoangiography ◽

Arteriovenous Fistulae ◽

Intracranial Dural Arteriovenous Fistulae

Abstract BACKGROUND: Indocyanine green videoangiography (IGV) raises important limitations when we use it in vascular pathology, especially in cases with arterialization of the venous system such as arteriovenous malformations and fistulae. OBJECTIVE: Our objective was to provide a simple procedure that overcomes the limitations of conventional IGV. We define IGV in negative (IGV-IN), so-called because, in its first phase, the vessel to analyze is clipped, and we report 3 cases of intracranial dural arteriovenous fistulae treated with this procedure. METHODS: In 2011, we applied IGV-IN to 3 patients at our center with Borden type III intracranial arteriovenous fistulae. RESULTS: In all 3 cases, IGV-IN enabled both diagnosis and post-dural arteriovenous fistula exclusion control in 1 integrated procedure no longer than 1 minute, requiring only 1 visualization. CONCLUSION: IGV-IN is an improvement over the conventional IGV method and is able to provide more information in a shorter period of time. It is an intuitive and highly visual procedure, and, more importantly, it is reversible. Studies with larger samples are necessary to determine whether IGV-IN can further reduce the need for postoperative digital subtraction angiography.

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