Intracranial dural arteriovenous fistulas with spinal venous drainage: relation between clinical presentation and angiographic findings.
OBJECTIVE
To investigate why some patients with an intracranial dural arteriovenous fistula (DAVF) with spinal venous drainage have myelopathy and others do not.


METHODS
We reviewed the clinical and radiologic data for 12 patients who had a DAVF with spinal venous drainage diagnosed at our institutions from 1982 to 1995.


RESULTS
Six patients had progressive spinal cord indications of disease (patients with myelopathy) and six others (patients without myelopathy) had cerebral indications (five had intracranial hemorrhage and one had a seizure). Cerebral angiography showed a posterior fossa DAVF with spinal venous drainage in all cases. The clinical presentation of DAVFs with spinal venous drainage was compared with the extent of the drainage. In patients without myelopathy, the spinal venous drainage exited the intradural canal via the cervical medullary-radicular veins and was therefore limited to the cervical perimedullary veins. In patients with myelopathy, no medullary-radicular vein was seen, and the venous drainage descended along the perimedullary veins of the entire spinal cord toward the conus medullaris.


CONCLUSIONS
We found an exact relation between clinical presentation and venous drainage of DAVFs with spinal venous drainage. Patients had no myelopathy when the venous drainage was limited to the cervical cord; myelopathy was present when the venous drainage descended toward the conus medullaris.
Brunereau
L
L
Service de Neuroradiologie et Angiographie Thérapeutique, Hôpital Lariboisière, Paris, France.
Gobin
Y P
YP
Meder
J F
JF
Cognard
C
C
Tubiana
J M
JM
Merland
J J
JJ
D000328:Adult; D000368:Aged; D000792:Angiography; D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology; D003287:Contrast Media; D003392:Cranial Sinuses / Q000000981:diagnostic imaging / Q000473:pathology; D004388:Dura Mater / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000209:etiology; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging; D013118:Spinal Cord Diseases / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D014057:Tomography, X-Ray Computed
D003287:Contrast Media