Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>In this paper the authors' goal was to review the clinical features and outcome of patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with hemorrhage.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A retrospective study of 28 patients with DAVFs who presented with intracranial hemorrhage to 2 separate institutions was performed. The information reviewed included clinical presentation, location and size of hemorrhage, angiographic features, treatment, and clinical and radiologically documented outcomes. Clinical and radiological follow-up were available in 27 of 28 patients (mean follow-up 17 months).</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The vast majority of patients were male (86%), and the most common presenting symptom was sudden-onset headache. All DAVFs had cortical venous drainage, and about one-third were associated with a venous varix. The most common location was tentorial (75%). Treatment ranged from endovascular (71%), surgical (43%), Gamma Knife surgery (4%), or a combination of modalities. The majority of fistulas (75%) were completely obliterated, and most patients experienced excellent clinical outcome (71%, modified Rankin Scale score of 0 or 1). There were no complications in this series.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Case series, including the current one, suggest that the vast majority of patients who present with intracranial hemorrhage from a DAVF are male. The most common location for DAVFs presenting with hemorrhage is tentorial. Excellent outcomes are achieved with individualized treatment, which includes various therapeutic strategies alone or in combination. Despite the hemorrhagic presentation, almost two-thirds of patients experience a full recovery with no or minimal residual symptoms.</jats:p></jats:sec>

Intramedullary hemorrhage from a thoracolumbar dural arteriovenous fistula

“…Similarly, Aviv et al [2] found that a venous varix was present in 7 (35%) of the 20 cervical dural AVF patients presenting with subarachnoid hemorrhage, compared with 1 (5%) in the nonhemorrhage group. These findings have been corroborated in a series of intracranial dural AVFs [109]. In our patient, the rate of arteriovenous transit was faster than that of other patients presenting without hemorrhage (1 vs. 2-3 [29] 20 0 0 Blackburn et al [30] 17 0 0 Bl ehaut et al [31] 10 0 0 Bowen et al [32] 8 0 0 Bradac et al [33] 13 0 0 Burrows et al [34] 1 0 0 Cabrera et al [35] 1 0 0 Cenzato et al [36] 37 0 0 Cenzato et al [37] 1 0 0 Cordato et al [38] 1 0 0 Criscuolo et al [39] 1 0 0 Deen et al [40] 1 0 0 Eskandar et al [41] 18 0 0 Finsterer et al [42] 1 0 0 Foote et al [43] 1 0 0 Gilbertson et al [44] 55 0 0 Hage et al [45] 5 0 0 Hall et al [46] 3 0 0 Hanakita et al [47] 2 0 0 Hassler et al [48] 18 0 0 Hasuo et al [49] 2 0 0 Houdart et al [50] 1 0 0 Huffmann et al [51] 18 0 0 Hurst et al [ seconds), and the draining vein was associated with a venous varix (Figs.…”

Intracranial Dural Arteriovenous Fistulae

“…Since venous varices are often the source of hemorrhage, the hemorrhage can be remote from the actual location of the AV shunt. 29 …”

Changing Clinical and Therapeutic Trends in Tentorial Dural Arteriovenous Fistulas: A Systematic Review

“…In fact, the overwhelming majority of patients with DAVFs who present with hemorrhage have TDAVFs. 5 It is now recognized that the presence of retrograde leptomeningeal drainage, not DAVF location, is the major determining factor of the mode of clinical presentation, and TDAVFs are universally associated with retrograde leptomeningeal drainage. 11 The natural history of symptom- atic DAVF with retrograde leptomeningeal drainage is particularly unfavorable.…”

“…Because of this, these lesions are treated aggressively on diagnosis. [3][4][5] Traditionally, surgical resection was the only treatment available for these lesions. However, endovascular embolization, either alone or in combination with surgery, is increasingly used.…”