title: Quantifying the Cerebral Hemodynamics of Dural Arteriovenous Fistula in Transverse Sigmoid Sinus Complicated by Sinus Stenosis: A Retrospective Cohort Study.
abstract: Sinus stenosis occasionally occurs in dural arteriovenous fistulas. Sinus stenosis impedes venous outflow and aggravates intracranial hypertension by reversing cortical venous drainage. This study aimed to analyze the likelihood of sinus stenosis and its impact on cerebral hemodynamics of various types of dural arteriovenous fistulas.
  
  
  
  Forty-three cases of dural arteriovenous fistula in the transverse-sigmoid sinus were reviewed and divided into 3 groups: Cognard type I, type IIa, and types with cortical venous drainage. Sinus stenosis and the double peak sign (occurrence of 2 peaks in the time-density curve of the ipsilateral drainage of the internal jugular vein) in dural arteriovenous fistula were evaluated. "TTP" was defined as the time at which a selected angiographic point reached maximum concentration. TTP of the vein of Labbé, TTP of the ipsilateral normal transverse sinus, trans-fistula time, and trans-stenotic time were compared across the 3 groups.
  
  
  
  Thirty-six percent of type I, 100% of type IIa, and 84% of types with cortical venous drainage had sinus stenosis. All sinus stenosis cases demonstrated loss of the double peak sign that occurs in dural arteriovenous fistula. Trans-fistula time (2.09 seconds) and trans-stenotic time (0.67 seconds) in types with cortical venous drainage were the most prolonged, followed by those in type IIa and type I. TTP of the vein of Labbé was significantly shorter in types with cortical venous drainage. Six patients with types with cortical venous drainage underwent venoplasty and stent placement, and 4 were downgraded to type IIa.
  
  
  
  Sinus stenosis indicated dysfunction of venous drainage and is more often encountered in dural arteriovenous fistula with more aggressive types. Venoplasty ameliorates cortical venous drainage in dural arteriovenous fistulas and serves as a bridge treatment to stereotactic radiosurgery in most cases.
authors.affiliation: From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.).|School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: W-Y
authors.identifier: 0000-0003-2640-8664
authors.initials: WY
authors.lastname: Guo
authors.affiliation: Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: C-C J
authors.identifier: 0000-0003-4691-2913
authors.initials: CJ
authors.lastname: Lee
authors.affiliation: From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.) bcjlin@gmail.com.|School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: C-J
authors.identifier: 0000-0003-2370-6316
authors.initials: CJ
authors.lastname: Lin
authors.affiliation: Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: H-C
authors.identifier: 0000-0002-4949-5417
authors.initials: HC
authors.lastname: Yang
authors.affiliation: From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.).|School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: H-M
authors.identifier: 0000-0001-6466-3792
authors.initials: HM
authors.lastname: Wu
authors.affiliation: From the Department of Radiology (W.-Y.G., C.-J.L., H.-M.W., C.-C.W.).|School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: C-C
authors.identifier: 0000-0003-0229-2150
authors.initials: CC
authors.lastname: Wu
authors.affiliation: Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: W-Y
authors.identifier: 0000-0002-9343-6289
authors.initials: WY
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery (C.-C.J.L., H.-C.Y., W.-Y.C., K.-D.L.), Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.|School of Medicine (W.-Y.G., C.-C.J.L., C.-J.L., H.-C.Y., H.-M.W., C.-C.W., W.-Y.C., K.-D.L.), National Yang-Ming University, Taipei, Taiwan.
authors.forename: K-D
authors.identifier: 0000-0003-3883-9955
authors.initials: KD
authors.lastname: Liu
mesh_terms: D000328:Adult; D020785:Central Nervous System Vascular Malformations / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D002533:Cerebral Angiography; D003251:Constriction, Pathologic / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D054064:Transverse Sinuses / Q000473:pathology* / Q000503:physiopathology*