title: "Loop-like formation" in the cortical venous reflux of dural arteriovenous fistula with intracranial hemorrhage.
abstract: OBJECTIVE
  Cortical venous reflux (CVR) in dural arteriovenous fistulas (AVFs) is a well-known risk factor for intracranial hemorrhage. However, the impact of the angiographic characteristics of CVR on the risk of intracranial hemorrhage remains unclear. This study retrospectively reviewed the angioarchitectural features of CVR to assess their influence on the risk of intracranial hemorrhage in dural AVFs.
  
  
  METHODS
  We retrospectively evaluated 68 consecutive patients with dural AVFs treated at our hospital between September 2001 and February 2010. In all cases, the angioarchitectural features of CVR were analyzed using cerebral angiography with a special focus on the venous drainage pattern of dural AVFs. "Loop-like formation" was defined as at least one CVR forming a curvature and connection adjacent to the original arteriovenous shunt point.
  
  
  RESULTS
  Ten dural AVF patients (14.7%) presented with intracranial hemorrhage. All ten dural AVFs with intracranial hemorrhage showed CVR with a "loop-like formation" on angiography. This association was found to be statistically significant (P<0.0001).
  
  
  CONCLUSIONS
  "Loop-like formation" in CVR may be a risk factor for intracranial hemorrhage resulting from dural AVF. This angioarchitectural feature of venous drainage may be a useful prognostic indicator, and hence should be a point of focus during treatment decisions.
authors.affiliation: Department of Neurosurgery, Kobe City Medical Center General Hospital; Kobe, Hyogo, Japan. Electronic address: koyanagm@kuhp.kyoto-u.ac.jp.
authors.forename: Masaomi
authors.initials: M
authors.lastname: Koyanagi
authors.affiliation: Department of Neurosurgery, Kobe City Medical Center General Hospital; Kobe, Hyogo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Sakai
authors.affiliation: Department of Neurosurgery, Kobe City Medical Center General Hospital; Kobe, Hyogo, Japan.
authors.forename: Hidemitsu
authors.initials: H
authors.lastname: Adachi
authors.affiliation: Department of Neurosurgery, Kobe City Medical Center General Hospital; Kobe, Hyogo, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ueno
authors.affiliation: Department of Neurosurgery, Kobe City Medical Center General Hospital; Kobe, Hyogo, Japan.
authors.forename: Takeharu
authors.initials: T
authors.lastname: Kunieda
authors.affiliation: Department of Neurosurgery, Kobe City Medical Center General Hospital; Kobe, Hyogo, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Imamura
authors.affiliation: Department of Neurosurgery, Kobe City Medical Center General Hospital; Kobe, Hyogo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kikuchi
mesh_terms: D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000379:methods*; D002550:Cerebral Veins / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Cerebral hemorrhage; Cortical venous reflux; Dural arteriovenous fistula; Venous hypertension