Assessment of dural arteriovenous fistulae by transcranial color-coded duplex sonography.
OBJECTIVE
To study hemodynamic changes and to determine the value of contrast-enhanced transcranial color-coded sonography (TCCS) for the evaluation of dural arteriovenous fistulae (DAVF) before and after transcatheter embolization.


METHODS
Twenty-four patients (mean age 61+/-11 years) with occipitally located DAVF were studied with contrast-enhanced TCCS using the transtemporal bone window in transverse-axial and coronal insonation planes. Blood flow velocity measurements of all depictable basal cerebral veins and sinuses were obtained before and after transcatheter embolization. Pretreatment and post-treatment flow velocity values were compared.


RESULTS
Four of the 24 patients (17%) could not be studied because of an insufficient temporal bone window. In all remaining patients (n=20), draining veins/sinuses could be identified because of pathologically increased blood flow velocities with peak systolic flow velocities of >50 cm/s. Of the 27 draining vessels depicted by DSA, TCCS correctly identified 25 (93%): the basal vein (3 of 3), the straight sinus (3 of 3), the superior sagittal sinus (1 of 3), the transverse sinus (9), the sigmoid sinus (4), and the superior petrosal sinus (5/5). However, TCCS failed to depict supplementary drainage via cortical veins. After transcatheter embolization, mean reduction of blood flow velocity was 44+/-18% (P<0.01) compared with pretreatment values.


CONCLUSIONS
Contrast-enhanced TCCS is a promising technique for monitoring embolization of DAVF, follow-up after complete fistula occlusion, and may even be useful as a screening tool in patients with pulsatile tinnitus.
Harrer
Judith U
JU
Department of Neurology, Aachen University Hospital, Aachen, Germany. Judith.Harrer@web.de
Popescu
Octavian
O
Henkes
Hans H
HH
Klötzsch
Christof
C
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018615:Ultrasonography, Doppler, Color; D017585:Ultrasonography, Doppler, Transcranial