Type I cerebral dural arteriovenous fistulas of the lateral sinus: clinical features in 24 patients

Abstract

To review the clinical and diagnostic characteristics of type I cerebral dural arteriovenous fistulas (CDAVF) of the lateral sinus medical records of 24 patients with Type I CDAVF were retrospectively reviewed. All patients were interviewed aiming at presenting symptoms, impact on daily functioning, diagnostic delay, relevant medical history and post-treatment status. Nineteen of 24 patients (79%) were women. The median age at the time of diagnosis was 56 years (range 32-69). Unilateral pulsatile tinnitus was the presenting symptom in all patients. A bruit could be heard at auscultation on the retroauricular skull in all patients. The median diagnostic delay was 17.9 months (range 1-120). Standardized magnetic resonance imaging (MRI) of the brain was normal in all patients. The diagnosis of CDAVF was confirmed on cerebral angiography. In conclusion, CDAVF type I of the lateral sinus occurs predominantly in middle aged women and presents with unilateral pulsatile tinnitus, which resulted in impairment of social and occupational functioning in the vast majority of patients. An audible bruit at retroauricular auscultation confirms the clinical diagnosis of a cerebral dural fistula. MRI is not helpful in the diagnosis and cerebral angiography is indicated to classify the dural fistula.

Dural Arteriovenous Fistulas

“…25 2) Benign dAVFs are most common among women, 26,27 whereas dAVFs with cortical venous drainage appear to be most common among men. 28,29 3) Multiple intracranial dAVFs are present in 6.7% of patients.…”

“…47 In a series of 24 patients with Borden Type I dAVFs of the transverse-sigmoid region, pulsatile tinnitus was the presenting symptom in all patients. 27 A vascular disorder is present in 42% of patients with pulsatile tinnitus; a non-vascular disorder is the cause of pulsatile tinnitus in 14% of patients. 47 1 …”

Pulsatile Tinnitus

“…As a natural repair mechanism, vascular bypasses tend to develop around the occlusion, resulting into a dural AVM [24]. If the dural AVM is symptomatic, or if it is asymptomatic with leptomeningeal drainage, these lesions should be embolized, usually in multiple sessions [25,26]. In benign lesions with only tinnitus or embolization failures, gamma knife surgery is an alternative option if no cortical venous drainage is present [27].…”

Manejo quirúrgico de las malformaciones arteriovenosas durales craneales: Serie de seis casos

“…Constituyen entre el 10 al 15% de todas las conexiones arteriovenosas anómalas intracraneales 1,10,11 . A pesar de estar descritos, en la literatura, casos de cierre espontáneo en fístulas de bajo flujo 2,4,5,8,10 , su diagnóstico se basa en los síntomas neurológicos secundarios a: el efecto masa, el fenómeno de robo, la hipertensión venosa, su capacidad irritativa sobre la corteza cerebral o los efectos devastadores de su sangrado.…”