Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas. Clinical article.
OBJECTIVE
Dural arteriovenous fistulas (DAVFs) with leptomeningeal venous reflux generally pose a high risk of aggressive manifestations including hemorrhage. Among DAVFs, there is a peculiar type that demonstrates direct drainage into the bridging vein rather than the dural venous sinus. The purpose of this study was to investigate the characteristics of DAVFs that drain directly into the petrosal vein or the bridging vein of the medulla oblongata.


METHODS
Eleven consecutive cases of DAVFs that drained directly into the petrosal vein and 6 that drained directly into the bridging vein of the medulla were retrospectively reviewed. These cases were evaluated and/or treated at Hospital de Bicêtre in Paris, France, over a 27-year period. A review of previously reported cases was also performed.


RESULTS
Both of these "extrasinusal"-type DAVFs demonstrated very similar characteristics. There was a significant male predominance (p < 0.001) for this lesion, and a significantly higher incidence of aggressive neurological manifestations including hemorrhage or venous hypertension than in DAVFs of the transverse-sigmoid or cavernous sinus (p < 0.001). This finding was considered to be attributable to leptomeningeal venous reflux. Regarding treatment, endovascular embolization (either transarterial or transvenous) is frequently difficult, and surgery may be an effective therapeutic choice in many instances.


CONCLUSIONS
Embryologically, both the petrosal vein and the bridging vein of the medulla are cranial homologs of the spinal cord emissary bridging veins that drain the pial venous network. The authors believe that DAVFs in these locations may be included in a single category with spinal DAVFs because of their similar clinical characteristics.
Mitsuhashi
Yutaka
Y
Service de Neuroradiologie Diagnostique et Therapeutique, Hospital de Bicêtre, Paris, France. y-mitsuhashi@mtf.biglobe.ne.jp
Aurboonyawat
Thaweesak
T
Pereira
Vitor Mendes
VM
Geibprasert
Sasikhan
S
Toulgoat
Frédérique
F
Ozanne
Augustin
A
Lasjaunias
Pierre
P
D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications / Q000601:surgery*; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation / Q000502:physiology*; D004388:Dura Mater / Q000098:blood supply; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008526:Medulla Oblongata / Q000098:blood supply* / Q000601:surgery*; D008875:Middle Aged; D009069:Movement Disorders / Q000209:etiology; D012039:Regional Blood Flow / Q000502:physiology; D013122:Spinal Diseases / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000150:complications; D014057:Tomography, X-Ray Computed