Objective: To analyze and update the clinical symptomatology, CT and MRI findings, angiographic features, and therapeutic outcomes of patients with dural arteriovenous fistulas (DAVFs). Background: Studies of DAVFs in a large number of patients have seldom appeared in neurology literature. Methods: The authors investigated 60 consecutive patients with DAVFs who were admitted between January 1991 and January 2001. The DAVFs were graded into five types according to the classification of Cognard et al. [Radiology 1995;194:671–680]. Presumable etiologies, clinical features, imaging findings and therapeutic outcomes were evaluated on the basis of the location and type of DAVFs. Results: Sinus thrombosis, previous trauma, craniotomy, cerebral infarction and acupuncture were detected as possible etiologic factors of DAVFs. The cavernous sinus (57%) was the most common location of DAVFs. Although the neurological symptoms were closely related to the location of the DAVFs, in some patients, there were also symptoms that did not reflect the location. Although the women outnumbered the men, the men presented with aggressive neurological manifestations more often (p < 0.05). Ten out of 12 patients (83%) with DAVFs involving locations other than the large sinuses presented with aggressive neurological manifestations. 70% of brain CTs and 81% of brain MRIs showed abnormal findings suggestive of DAVFs. Of 33 patients who underwent only endovascular embolization, 29 patients (88%) were cured or improved. Radiosurgery and surgical excision done in some patients provided fair results. Patients with DAVFs involving large sinuses showed a better therapeutic outcome than those in whom locations other than the large sinuses were involved, while patients without venous ectasia had more a favorable outcome than those with it (each, p < 0.01). Conclusions: DAVFs result from various etiologic factors, show diverse manifestations usually reflecting the location and can be treated successfully in most patients. Factors related to poor clinical outcome include male sex, the presence of venous ectasia and involved locations other than the large sinuses.

Keywords:
Intracranial dural arteriovenous fistulas, Endovascular embolization, Radiosurgery, Surgical excision
1.
Newton TH, Cronqvist S: Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 1969;93:1071–1078.
2.
Houser OW, Baker HL Jr, Rhoton AL Jr, Okazaki H: Intracranial dural arteriovenous malformations. Radiology 1972;105:55–64.
3.
Awad IA, Little JR, William PA, Akrawi WP, Ahl J: Intracranial dural arteriovenous malformations: Factors predisposing to an aggressive neurological course. J Neurosurg 1990;72:839–850.
4.
Lasjaunias P, Chiu M, Brugge KT, Tolia A, Hurth M, Bernstein M: Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 1986;64:724–730.
5.
Cognard C, Gobin YP, Pierot L, et al: Cerebral dural arteriovenous fistulas: Clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995;194:671–680.
6.
Borden JA, Wu JK, Shucart WA: A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 1995;82:166–179.
7.
Houser OW, Campbell JK, Campbell RJ, Sundt TM Jr: Arteriovenous malformation affecting the transverse dural venous sinus – An acquired lesion. Mayo Clin Proc 1979;54:651–661.
8.
Chaudhary MY, Sachdev VP, Cho SH, Weitzner I Jr, Puljic S, Huang YP: Dural arteriovenous malformation of the major venous sinuses: An acquired lesion. AJNR Am J Neuroradiol 1982;3:13–19.
9.
Herman JM, Spetzler RF, Bederson JB, Kurbat JM, Zabramski JM: Genesis of a dural arteriovenous malformation in a rat model. J Neurosurg 1995;83:539–545.
10.
Lawton MT, Jacobowitz R, Spetzler RF: Redefined role of angiogenesis in the pathogenesis of dural arteriovenous malformations. J Neurosurg 1997;87:267–274.
11.
Ozawa T, Miyasaka Y, Tanaka R, Kurata A, Fujii K: Dural-pial arteriovenous malformation after sinus thrombosis. Stroke 1998;29:1721–1724.
12.
Willinsky R, Terbrugge K, Montanera W, Mikulis D, Wallace MC: Venous congestion: An MR finding in dural arteriovenous malformations with cortical venous drainage. AJNR Am J Neuroradiol 1994;15:1501–1507.
13.
Uchino A, Kato A, Kuroda Y, Shimokawa S, Kudo S: Pontine venous congestion caused by dural carotid-cavernous fistula: Report of two cases. Eur Radiol 1997;7:405–408.
14.
Takahashi S, Tomura N, Watarai J, Mizoi K, Manabe H: Dural arteriovenous fistula of the cavernous sinus with venous congestion of the brain stem: Report of two cases. AJNR Am J Neuroradiol 1999;20:886–888.
15.
Shintani S, Tsuruoka S, Shiigai T: Carotid-cavernous fistula with brainstem congestion mimicking tumor on MRI. Neurology 2000;55:1929–1931.
16.
Halbach VV, Higashida RT, Hieshima GB, Hardin CW, Pribram H: Transvenous embolization of dural fistulas involving the cavernous sinus. AJNR Am J Neuroradiol 1989;10:377–383.
17.
Halbach VV, Higashida RT, Hieshima GB, Mehringer CM, Hardin CW: Transvenous embolization of dural fistulas involving the transverse and sigmoid sinuses. AJNR Am J Neuroradiol 1989;10:385–392.
18.
Urtasun F, Biondi A, Casaco A, et al: Cerebral dural arteriovenous fistulas: Percutaneous transvenous embolization. Radiology 1996;199:209–217.
19.
Roy D, Raymond J: The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 1997;40:1133–1144.
20.
Lewis AI, Tomsick TA, Tew JM Jr: Management of tentorial dural arteriovenous malformations: Transarterial embolization combined with stereotactic radiation or surgery. J Neurosurg 1994;81:851–859.
21.
Link MJ, Coffey RJ, Nichols DA, Gorman DA: The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas. J Neurosurg 1996;84:804–809.
22.
Pollock BE, Nichols DA, Garrity JA, Gorman DA, Stafford SL: Stereotactic radiosurgery and particulate embolization for cavernous sinus dural arteriovenous fistulae. Neurosurgery 1999;45:459–467.
23.
Lawton MT, Chun J, Wilson CB, Halbach VV: Ethmoidal dural arteriovenous fistulae: An assessment of surgical and endovascular management. Neurosurgery 1999;45:805–811.
24.
Collice M, D’Aliberti G, Arena O, Solaini C, Fontana RA, Talamonti G: Surgical treatment of intracranial dural arteriovenous fistulae: Role of venous drainage. Neurosurgery 2000;47:56–67.
25.
Wecht DA, Awad IA: Carotid cavernous and other dural arteriovenous fistulas; in Welch KMA, Caplan LR, Reis DJ, Siesjo BK, Weir B (eds): Primer on Cerebrovascular Diseases. San Diego, Academic Press, 1997, pp 541–548.
26.
Brown RD Jr, Wiebers DO, Nichols DA: Intracranial dural arteriovenous fistulae: Angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients. J Neurosurg 1994;81:531–538.
27.
Preter M, Tzourio C, Ameri A, Bousser MG: Long-term prognosis in cerebral venous thrombosis: Follow-up of 77 patients. Stroke 1996;27:243–246.
28.
Hashimoto H, Iida J, Masui K, Nishi N, Yonezawa T, Sakaki T: Dural arteriovenous malformation of the anterior cranial fossa occurring after bifrontal craniotomy. Surg Neurol 1998;49:47–50.
29.
Sasaki T, Hoya K, Kinone K, Kirino T: Postsurgical development of dural arteriovenous malformations after transpetrosal and transtentorial operations. Neurosurgery 1995;37:820–824.
30.
Phelps CD, Thompson HS, Ossoinic KC: The diagnosis and prognosis of atypical carotid-cavernous fistula (red-eyed shunt syndrome). Am J Ophthalmol 1982;93:423–436.
31.
Fiore PM, Latina MA, Shingleton BJ, Rizzo JF, Ebert E, Bellows AR: The dural shunt syndrome. I. Management of glaucoma. Ophthalmology 1990;97:56–62.
32.
Kasai K, Iwasa H, Yamada N, Asamoto S, Abe T, Nemoto S: Combined treatment of a dural arteriovenous malformation of the lateral sinus using transarterial and direct lateral sinus embolisation. Neuroradiology 1996;38:494–496.
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2002
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