title: Spontaneous angiographic changes in venous drainage patterns related to symptom changes in patients with untreated cavernous sinus dural arteriovenous fistula.
abstract: BACKGROUND
  We evaluated the relationship between symptomatic and angiographic changes in untreated cavernous sinus dural arteriovenous fistulas (CSdAVFs), focusing on venous drainage patterns.
  
  
  METHODS
  The clinical and radiologic features of 34 cases of untreated CSdAVF were retrospectively reviewed. We classified venous drainage patterns as type I (only antegrade drainage), type II (combined antegrade drainage and venous reflux), type III (venous reflux without antegrade drainage), or type IV (stasis or occlusion of venous reflux). Symptom changes were categorized as improvement, aggravation of initial symptoms, or symptom pattern change.
  
  
  RESULTS
  Twenty-one patients (61 %) showed symptom changes during follow-up (median, 12; range, 3-151 months). In the symptom improvement group (n = 10), patients who underwent follow-up angiography (n = 4) exhibited spontaneous occlusion. In the symptom aggravation group (n = 4), new venous reflux developed in 2 patients (type I to type II) and spontaneous occlusion in 2 patients (type III to spontaneous occlusion). In the symptom pattern change group (n = 7), 2 patients showed new venous reflux (type I to type II), and 5 showed stasis or occlusion of an engorged ophthalmic vein (type II or III to type IV). Angiographic regression was observed in all type III and IV patients, and cortical venous reflux (CVR) developed in 1 type I patient.
  
  
  CONCLUSIONS
  Symptom changes correlated with chronological angiographic changes. Without treatment, most CSdAVFs behaved benignly and had a low incidence of CVR. Therefore, close observation is a possible protocol for managing CSdAVFs that have tolerable symptoms, no CVR, and no antegrade drainage despite aggravation or fluctuation in symptoms.
authors.affiliation: Department of Neurosurgery, Bundang Jesaeng Hospital, Sungnam, Korea.
authors.forename: Jai Ho
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Kyung Il
authors.initials: KI
authors.lastname: Jo
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, Republic of Korea.
authors.forename: Keon Ha
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, Republic of Korea. drpjeon@gmail.com.
authors.forename: Pyoung
authors.initials: P
authors.lastname: Jeon
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Je Young
authors.initials: JY
authors.lastname: Yeon
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jong Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Seung Chyul
authors.initials: SC
authors.lastname: Hong
mesh_terms: D002426:Cavernous Sinus / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002533:Cerebral Angiography / Q000379:methods; D002550:Cerebral Veins / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D063189:Symptom Assessment
keywords: Cavernous sinus; Dural arteriovenous fistula; Natural history; Spontaneous regression