New concept in cavernous sinus dural arteriovenous fistula: correlation with presenting symptom and venous drainage patterns.
OBJECTIVE
An extradurally located cavernous sinus dural arteriovenous fistula (CSDAVF) exhibits different clinical behavior from other dural arteriovenous fistulas (DAVFs) located between 2 dural leaves. The aim of this study is to define angiographic types of CSDAVF associated with presenting symptom (Sx) and venous drainage patterns.


METHODS
CSDAVFs during a mean of 23-month follow-up period of 58 patients (17 to 73 years, male:female ratio=8:50) were retrospectively analyzed. The 3 types of CSDAF, ie, proliferative (PT), restrictive (RT), and late restrictive (LRT) types, were categorized by the degrees and patterns of prominent arteriovenous shunt as well as venous flow. The status of the venous connection with CS and the presenting Sx patterns classified as orbital (OrbSxP), ocular (OcuSxP), cavernous (CavSxP), and cerebral (CerSxP) were associated with angiographic types as well as symptom onset, age, and gender. Correlations of discrete and categorical variables were statistically analyzed using the chi2 or Fisher exact test.


RESULTS
PT (n=23) and RT (n=23) of CSDAVF were more common than LRT (n=12) (P=0.016) in patients with younger than 65 years and were related to OrbSxP (P=0.015) and CavSxP (P=0.038) in contrast to LRT to OcuSxP (P=0.004). Early onset of Sxs was related to the OrbSxP (P=0.08) and CavSxP (P<0.001). CerSxP (5%) was noted in RT or LRT. OrbSxP was related to the superior ophthalmic venous drainage (P=0.026) and CavSxP to the inferior petrosal sinus (P=0.046) and posterior fossa venous drainages (P=0.014). Seven patients revealed chronological progression of CSDAVF from PT to LRT and even to complete healing.


CONCLUSIONS
CSDAVF presents as 3 distinctive angiographic types and is associated with presenting Sxs and venous drainage patterns.
Suh
Dae Chul
DC
Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, 388-1 Poongnap Dong, Songpa-Gu, Seoul, 138-736, Korea. dcsuh@www.amc.seoul.kr
Lee
Jeong Hyun
JH
Kim
Sang Joon
SJ
Chung
Sun Ju
SJ
Choi
Choong Gon
CG
Kim
Hyun Jeong
HJ
Kim
Chang Jin
CJ
Kook
Michael
M
Ahn
Hyo-Sook
HS
Kwon
Sun Uck
SU
Kim
Jong Sung
JS
D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D002426:Cavernous Sinus / Q000473:pathology*; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis*; D002533:Cerebral Angiography / Q000379:methods*; D002550:Cerebral Veins / Q000473:pathology*; D002560:Cerebrovascular Circulation; D003392:Cranial Sinuses / Q000473:pathology; D018450:Disease Progression; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors