Spontaneous angiographic conversion of intracranial dural arteriovenous shunt: long-term follow-up in nontreated patients.
OBJECTIVE
Dural arteriovenous shunt (DAVS) is a disease in which abnormal arteriovenous communications develop within the dura. Some case series have suggested DAVS may evolve over time, but the natural history is poorly understood. In this study, we aimed to define the incidence and clinical characteristics of patients with DAVS showing spontaneous angiographic pattern conversion.


METHODS
We assessed clinical and angiographic features of patients with angiographic conversion without any treatment from a single center database consisting of 335 DAVS cases. Spontaneous angiographic conversion was defined as complete occlusion of a pre-existing DAVS or conversion of a benign into an aggressive lesion on follow-up diagnostic subtraction angiography.


RESULTS
One hundred twelve patients were followed without treatment after the initial diagnosis of DAVS. Overall, we saw pattern conversion on angiography in 18 of the 112 cases (16.1%). Fourteen patients showed spontaneous occlusion of the shunt (12.5%); the most common locations of spontaneous obliteration were the transverse and cavernous sinuses. Four patients showed conversion to an aggressive lesion from benign DAVS (4.0%); all of these cases were associated with occlusion of the ipsilateral draining vein.


CONCLUSIONS
DAVS is a dynamic disorder, which will show chronological progression. Spontaneous angiographic obliteration or conversion into an aggressive type may occur on follow-up of untreated DAVSs.
Kim
Dong Joon
DJ
Department of Radiology, Yonsei University College of Medicine, Seoul, Korea. djkimmd@yuhs.ac
terBrugge
Karel
K
Krings
Timo
T
Willinsky
Robert
R
Wallace
Christopher
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000209:etiology; D002533:Cerebral Angiography / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004388:Dura Mater / Q000098:blood supply / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult