Dural arteriovenous fistulas with cortical venous drainage: incidence, clinical presentation, and treatment.
OBJECTIVE
Our purpose was to report our experience with intracranial dural arteriovenous fistulas (DAVFs) with cortical venous drainage during a 12-year period.


METHODS
Between January 1994 and January 2006, 91 patients with intracranial DAVFs presented at our institution, and 29 (32%) had cortical venous drainage. There were 5 women and 24 men (mean age, 53.9 years; range, 24-77). Clinical presentation was intraparenchymal or subarachnoid hemorrhage in 18 patients (62%), seizures in 4 patients (14%), visual symptoms in 2 patients (7%), pulsatile bruit in 1 patient (3%), and the DAVF (14%) was incidentally discovered in 4 patients.


RESULTS
In 2 patients, the DAVF had been obliterated spontaneously at the time of scheduled embolization 10 and 2 months after hemorrhage, respectively. Five patients with an anterior fossa DAVF underwent successful surgery. In 14 patients, the DAVF was completely occluded with embolization alone, and in 7 patients, embolization was followed by surgery. Altogether, complete occlusion was angiographically confirmed in 28 of 29 DAVFs; the result of radiosurgery of 1 DAVF is pending. There were no complications of surgery; embolization was complicated by postembolization hemorrhage in 1 patient (3%).


CONCLUSIONS
Most DAVFs with cortical venous drainage have an aggressive clinical course. Treatment by a neurovascular team by using surgery, embolization, or a combination resulted in cure in all cases, with a very low complication rate.
van Rooij
W J
WJ
Department of Radiology, St. Elisabeth Ziekenhuis, Tilburg, the Netherlands. radiol@knmg.nl
Sluzewski
M
M
Beute
G N
GN
D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy; D002533:Cerebral Angiography; D002540:Cerebral Cortex / Q000098:blood supply; D002543:Cerebral Hemorrhage / Q000209:etiology; D002550:Cerebral Veins / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000209:etiology