Progressive Myelopathy Caused by Intracranial Dural Arteriovenous Fistula

Versari, Pietro; D’Aliberti, Giuseppe; Talamonti, Giuseppe; Branca, V.; Boccardi, Edoardo; Collice, Massimo

doi:10.1227/00006123-199311000-00023

Cited by 39 publications

(19 citation statements)

References 11 publications

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“…6,14,16,18,19,21) The affected transverse-sigmoid sinuses showed some venous restriction in all cases, and isolated sinus, as in the present case, was observed in 3 cases. 6,18,21) The venous drainage descended into the cervical spinal perimedullary veins through the SPS in 2 cases. 16,21) However, the drainage patterns were not described in the other 4 cases.…”

Section: Discussionsupporting

confidence: 64%

“…2) Only a few cases of the type V dural AVF have been reported, most commonly located in the tentorium cerebelli, foramen magnum, and superior petrosal sinus. 2,6,13,14,16,18,19,21) Most patients with type V dural AVF presented with myelopathy, 1,6,14,18) whereas neurological deficits based on brainstem disturbance are rare. 13,16,19) Type V dural AVF of the transverse-sigmoid sinus is extremely rare.…”

Section: Introductionmentioning

confidence: 99%

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Sigmoid Sinus Dural Arteriovenous Fistula With Spinal Venous Drainage Manifesting as Only Brainstem-Related Neurological Deficits Without Myelopathy -Case Report-

Sugiura¹,

Nozaki²,

Sato³

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 69-year-old woman presented with an extremely rare sigmoid sinus dural arteriovenous fistula (AVF) with venous drainage into a spinal perimedullary vein manifesting only as brainstem dysfunction without myelopathy. Cerebral angiography showed retrograde venous drainage into both the brainstem and spinal cord through the ipsilateral bridging vein from the affected isolated sigmoid sinus. Magnetic resonance (MR) imaging showed a hyperintense lesion in the medulla oblongata and lower pons with increased apparent diffusion coefficient (ADC), and enhancement with contrast material. The dural AVF was successfully treated by transfemoral transvenous embolization from the contralateral side, but the hyperintense area and neurological symptoms persisted after the treatment. The neurological deficits were probably due to venous hypertension associated with accessory retrograde venous drainage into the brainstem. MR imaging enhancement of the lesion may be more closely related to the prognosis of neurological deficits than the ADC value.

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Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Sigmoid Sinus Dural Arteriovenous Fistula With Spinal Venous Drainage Manifesting as Only Brainstem-Related Neurological Deficits Without Myelopathy -Case Report-

Sugiura¹,

Nozaki²,

Sato³

et al. 2009

Neurol. Med. Chir.(Tokyo)

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“…[2][3][4][6][7][8]10,[15][16][17][19][20][21][22][23][24][25][26][27][28][29][30] The most common symptom is ascending myelopathy, starting as loss of sensation and motor function in the lower extremities and extending to the upper extremities. Sphincter function is impaired.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Ezura

Takahashi

et al. 2004

Neurol. Med. Chir.(Tokyo)

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A 73-year-old man presented with a rare transverse sinus dural arteriovenous fistula (dAVF) with venous reflux to the brainstem and medulla manifesting as brainstem and spinal cord edema mimicking brainstem infarction. Complete occlusion of the fistula was achieved by transvenous embolization, resulting in angiographic cure of the fistula and progressive improvement of the symptoms. Intracranial dAVFs with perimedullary venous drainage, type V according to the Cognard classification, are rare lesions with distinctive clinical, radiological, and therapeutic aspects. This case demonstrates that the symptoms of dAVF with perimedullary venous reflux are variable, so dAVF should be considered in patients with clinical and radiological findings suggestive of congestion in the brainstem and spinal cord. Dysfunction of the medulla and spinal cord caused by venous hypertension is the most probable cause of the neurological symptoms in such cases. Interventional therapy can lead to angiographic cure and resolution of the symptoms.

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“…We excluded DAVFs located in remote regions that drained into posterior fossa veins secondary to thrombosis of their "natural" outlets, in particular cavernous sinus or transversesigmoid lesions with venous occlusions. In the previously published literature, we found 30 cases of petrosal vein DAVFs 4,5,[7][8][9]13,16,21,30,33,[36][37][38]41,45,48,52,55,56,59,60 and 35 cases of medulla bridging vein DAVFs, 1,11,14,[17][18][19][20][22][23][24][25]31,32,35,39,40,43,46,50,51,53,58,61 all of which were well described with clinical and angiographic information. These previously reported cases were analyzed together, with special attention to their clinical characteristics.…”

Section: Methodsmentioning

confidence: 99%

Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas

Mitsuhashi

Aurboonyawat

Pereira

et al. 2009

JNS

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Object Dural arteriovenous fistulas (DAVFs) with leptomeningeal venous reflux generally pose a high risk of aggressive manifestations including hemorrhage. Among DAVFs, there is a peculiar type that demonstrates direct drainage into the bridging vein rather than the dural venous sinus. The purpose of this study was to investigate the characteristics of DAVFs that drain directly into the petrosal vein or the bridging vein of the medulla oblongata. Methods Eleven consecutive cases of DAVFs that drained directly into the petrosal vein and 6 that drained directly into the bridging vein of the medulla were retrospectively reviewed. These cases were evaluated and/or treated at Hospital de Bicêtre in Paris, France, over a 27-year period. A review of previously reported cases was also performed. Results Both of these “extrasinusal”-type DAVFs demonstrated very similar characteristics. There was a significant male predominance (p < 0.001) for this lesion, and a significantly higher incidence of aggressive neurological manifestations including hemorrhage or venous hypertension than in DAVFs of the transverse-sigmoid or cavernous sinus (p < 0.001). This finding was considered to be attributable to leptomeningeal venous reflux. Regarding treatment, endovascular embolization (either transarterial or transvenous) is frequently difficult, and surgery may be an effective therapeutic choice in many instances. Conclusions Embryologically, both the petrosal vein and the bridging vein of the medulla are cranial homologs of the spinal cord emissary bridging veins that drain the pial venous network. The authors believe that DAVFs in these locations may be included in a single category with spinal DAVFs because of their similar clinical characteristics.

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Progressive Myelopathy Caused by Intracranial Dural Arteriovenous Fistula

Cited by 39 publications

References 11 publications

Sigmoid Sinus Dural Arteriovenous Fistula With Spinal Venous Drainage Manifesting as Only Brainstem-Related Neurological Deficits Without Myelopathy -Case Report-

Sigmoid Sinus Dural Arteriovenous Fistula With Spinal Venous Drainage Manifesting as Only Brainstem-Related Neurological Deficits Without Myelopathy -Case Report-

Intracranial Dural Arteriovenous Fistula With Venous Reflux to the Brainstem and Spinal Cord Mimicking Brainstem Infarction-Case Report-

Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas

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