title: New concept in cavernous sinus dural arteriovenous fistula: correlation with presenting symptom and venous drainage patterns.
abstract: 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.
authors.affiliation: 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
authors.forename: Dae Chul
authors.initials: DC
authors.lastname: Suh
authors.forename: Jeong Hyun
authors.initials: JH
authors.lastname: Lee
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Kim
authors.forename: Sun Ju
authors.initials: SJ
authors.lastname: Chung
authors.forename: Choong Gon
authors.initials: CG
authors.lastname: Choi
authors.forename: Hyun Jeong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Kim
authors.forename: Michael
authors.initials: M
authors.lastname: Kook
authors.forename: Hyo-Sook
authors.initials: HS
authors.lastname: Ahn
authors.forename: Sun Uck
authors.initials: SU
authors.lastname: Kwon
authors.forename: Jong Sung
authors.initials: JS
authors.lastname: Kim
mesh_terms: 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