Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux.
OBJECTIVE
The natural history of aggressive (Borden 2 and 3) cranial dural arteriovenous fistulas (DAVFs) is not well described. Reported annual mortality and hemorrhage rates vary widely and range up to 20% per year. A consecutive single-center cohort of 236 cases that presented with a cranial DAVF between June 1984 and May 2001 was reviewed for the consequences of long-term persistent cortical venous reflux (CVR).


METHODS
A group of 118 cranial DAVFs was selected for the presence of CVR. All patients were offered treatment aimed at the disconnection of the CVR. Patients who declined or had partial treatment with persistence of the CVR had long-term clinical and angiographic follow-up to study the disease course of this select group.


RESULTS
Treatment was instituted in 101 of the 118 patients (85.6%). Three patients were lost to follow-up. The remaining 14 nontreated patients (11.9%) and the partially treated patients (n=6) were assessed clinically and angiographically over time. The mean follow-up in this select group was 4.3 years (86.9 patient-years). During follow-up, 7 patients suffered an intracranial hemorrhage (35%). The incidence of nonhemorrhagic neurological deficit was 30%. Nine patients (45%) died: 6 patients expired after a hemorrhage, and 3 patients died of progressive neurological deterioration. Two patients demonstrated a spontaneous closure of the DAVF (10%).


CONCLUSIONS
Persistence of the CVR in cranial DAVFs yields an annual mortality rate of 10.4%. Excluding events at presentation, in this series the annual risk for hemorrhage or nonhemorrhagic neurological deficit during follow-up was 8.1% and 6.9%, respectively, resulting in an annual event rate of 15.0%.
van Dijk
J Marc C
JM
Division of Neurosurgery and Division of Neuroradiology, University of Toronto Brain Vascular Malformations Study Group, Toronto, Ontario, Canada. vandijk.md@planet.nl
terBrugge
Karel G
KG
Willinsky
Robert A
RA
Wallace
M Christopher
MC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000145:classification / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D002540:Cerebral Cortex / Q000098:blood supply*; D002543:Cerebral Hemorrhage / Q000401:mortality; D002550:Cerebral Veins / Q000503:physiopathology*; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology; D018570:Risk Assessment; D013995:Time; D016896:Treatment Outcome