Clinical characteristics of dural arteriovenous shunts in 446 patients of three different ethnicities.
Dural arteriovenous shunts (DAVSs) developing in either the ventral, dorsal or lateral epidural spaces (VE, DE and LE-shunts) predictably drain in either cranio/spino-fugal or -petal directions. Associated conditions like venous outflow restrictions (VOR) may be responsible for changes in this drainage pattern. The goal of this study was to compare demographic, angiographic and clinical characteristics of different types of DAVS in Europe, South America, and Asia to find out whether the same clinical profile is present in different ethnicities. Charts and angiographic films of 446 patients with DAVS from three hospitals in Europe, Asia and South America were retrospectively evaluated. Clinical symptoms were separated into benign and aggressive and the presence or absence of cortical venous reflux (CVR) and VOR was noted. LE-shunts were present in elderly men and were always associated with CVR resulting in aggressive symptoms. VE-shunts were present in females and almost always had benign symptoms. There were no differences among the three populations for these shunts. DE-shunts in the Asian population were more aggressive secondary to a higher rate of VOR with associated CVR. VE-shunts rarely lead to CVR even in the presence of VOR, whereas LE-shunts invariably lead to CVR, irrespective of the population investigated. CVR in DE-shunts is not related to the primary disease (i.e. the shunt itself) but to associated factors that led to VOR. Since the occurrence of these varied between different ethnicities, DE-shunts were aggressive in the Asian population and benign in the European and South American populations.
Geibprasert
S
S
Department of Radiology, Ramathibodi Hospital, Mahidol University; Bangkok, Thailand - Department of Diagnostic Imaging, Hospital for Sick Children; Toronto, Canada - Dr. Geibprasert performed the statistical analyses - timo.krings@uhn.on.ca.
Krings
T
T
Pereira
V
V
Pongpech
S
S
Piske
R
R
Lasjaunias
P
P
Eur Radiol. 2005 Feb;15(2):267-78
15538580
Am J Anat. 1956 May;98(3):307-55
13362118
J Neurosurg. 1995 Feb;82(2):166-79
7815143
Neurosurgery. 1985 Mar;16(3):435-6
3982629
Neuroradiology. 1988;30(5):426-32
3211317
Childs Nerv Syst. 2004 Aug;20(8-9):526-37
15309473
Stroke. 1998 Aug;29(8):1721-4
9707217
J Neurosurg. 1986 May;64(5):724-30
3701421
J Neurosurg. 1985 Feb;62(2):248-56
3968564
J Anat. 2001 Jul-Aug;199(Pt 1-2):177-80
11523820
Stroke. 2002 Jun;33(6):1578-83
12052994
Surg Neurol. 1990 Aug;34(2):118-23
2367931
J Neurosurg. 2002 Oct;97(4):767-70
12405361
Stroke. 2002 May;33(5):1233-6
11988596
Stroke. 2008 Oct;39(10):2783-94
18635840
J Neurosurg. 1996 Nov;85(5):830-7
8893721
J Neurosurg. 1990 Jun;72(6):839-50
2140125
Scand J Plast Reconstr Surg. 1981;15(3):163-9
7051266
Radiology. 1995 Mar;194(3):671-80
7862961