Pretreatment and posttreatment evaluation of hemodynamic and metabolic parameters in intracranial dural arteriovenous fistulae with cortical venous reflux.
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.


CONCLUSIONS
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.
Kuroda
Satoshi
S
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan. skuroda@med.hokudai.ac.jp
Furukawa
Koji
K
Shiga
Tohru
T
Ushikoshi
Satoshi
S
Katoh
Chietsugu
C
Aoki
Takeshi
T
Ishikawa
Tatsuya
T
Houkin
Kiyohiro
K
Tamaki
Nagara
N
Iwasaki
Yoshinobu
Y
D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D002533:Cerebral Angiography; D002540:Cerebral Cortex / Q000098:blood supply / Q000000981:diagnostic imaging; D002550:Cerebral Veins / Q000601:surgery; D004621:Embolization, Therapeutic; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D014055:Tomography, Emission-Computed