Detection and Differentiation of Dural Arteriovenous Fistulas in the Transverse Sinus/Sigmoid Sinus and Cavernous Sinus Using Carotid Ultrasound

Abstract

Objectives Dural arteriovenous fistula (DAVFs) in the transverse sinus (TS)/sigmoid sinus (SS) and cavernous sinus (CS) are observed frequently in the clinic. This study aimed to detect DAVFs with ultrasound and compare carotid ultrasound findings between these conditions. Methods We retrospectively reviewed 26 patients with either a TS/SS DAVF or a CS DAVF who were admitted to our hospital for evaluation of DAVFs from 2014 to 2018. The shunt site decision was made by neuroendovascular experts, whereas carotid ultrasound examinations were performed by ultrasound specialists. The flow velocity of the ipsilateral external carotid artery was reviewed in all 26 patients, whereas that of the occipital artery (OA) was examined in 20 patients. Blood flow velocities were compared between the TS/SS DAVF and CS DAVF groups. Results The study included 18 patients with a TS/SS DAVF (11 women and 7 men; mean age ± SD, 65.3 ± 18.6 years) and 8 patients with a CS DAVF (7 women and 1 man; mean age, 70.4 ± 9.3 years). Evaluations of feeder arteries on cerebral angiography showed that all patients had dural branches from the internal carotid and middle meningeal arteries as feeders of CS DAVFs, whereas the OA was the major feeder source of all TS/SS DAVF cases. The end‐diastolic velocity (EDV) of the external carotid artery was significantly higher in patients with a TS/SS DAVF compared with those with a CS DAVF (P = .004). The EDV of the OA was significantly elevated in TS/SS DAVF cases compared with CS DAVF cases (P < .001). Conclusions Duplex ultrasound parameters are significantly different between patients with TS/SS and CS DAVFs. An increased EDV of the OA can predict the presence of a TS/SS DAVF.

Dilated MMA sign in cDAVF and other arterial feeders on 3D TOF MRA

“…The anastomoses formed between the occipital and ascending pharyngeal arteries with the branches of the MMA were the most likely explanation: the mastoid branch of the OA with the petrosquamous branch of the MMA and carotid and jugular ascending pharyngeal branches with the petrosal and petrosquamous MMA branches, respectively. 23 In the case of a dilated occipital artery, Hisaeda et al 26 found similar results when assessing this vessel in transverse-sigmoid lesions on ultrasound.…”

“… 23 In the case of a dilated occipital artery, Hisaeda et al. 26 found similar results when assessing this vessel in transverse-sigmoid lesions on ultrasound.…”

“…Most other studies assessed the feeders using techniques other than MRA, including ultrasound, CTA, and pseudo-continuous arterial spinlabeling. 18,[25][26][27] The occipital, ascending pharyngeal, meningohypophyseal trunk, and posterior meningeal arteries represent the majority of other feeders in MMA-fed lesions (n ¼ 32). Collectively, 83.67% (41/49) of these were deemed dilated on MRA.…”

“…Most other studies assessed the feeders using techniques other than MRA, including ultrasound, CTA, and pseudo-continuous arterial spin-labeling. 18 , 25 – 27 …”

Bilateral dural arteriovenous fistula diagnosed with neurovascular ultrasonography

“…When performing the examination, extra care should be taken to rule out any additional conditions that could be causing similar hemodynamic abnormalities [3]: stenosis or occlusion of the CCA, proximal vertebral artery stenosis or occlusion, severe stenosis of the distal ICA or proximal middle cerebral artery, and highly vascularized head and neck tumors. Moreover, examination of the occipital arteries [5] may further aid diagnosis, especially in AVFs with lower shunt volume.…”