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Neurosurgery. 2012 Feb;70(2):312-8; discussion 318-9. doi: 10.1227/NEU.0b013e318230966f.

The natural history of cranial dural arteriovenous fistulae with cortical venous reflux--the significance of venous ectasia.

Author information

1
Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Southampton, United Kingdom. dbulters@nhs.net

Abstract

BACKGROUND:

The quoted risk of hemorrhage from dural arteriovenous fistulae with cortical venous reflux varies widely, and the influence of angiographic grade on clinical course has not previously been reported.

OBJECTIVE:

To assess the risk of hemorrhage and the influence of angiographic grade on this risk, compared with known predictors of hemorrhage such as presentation.

METHODS:

Seventy-five fistulae with cortical venous reflux identified in our arteriovenous malformations clinic between 1992 and 2007 were followed up clinically, and their angiograms were reviewed.

RESULTS:

There were 8 hemorrhages in 90 years of follow-up. The annual incidence of hemorrhage before any treatment was 13%, and 4.7% after partial treatment, giving an overall incidence of 8.9% before definitive treatment. Borden and Cognard grades were poor discriminators of risk for lesions with the exception of Cognard type IV lesions. These lesions, characterized by venous ectasia, had a 7-fold increase in the incidence of hemorrhage (3.5% no ectasia vs 27% with ectasia). Patients presenting with hemorrhage (20%) or nonhemorrhagic neurological deficit (22%) had a higher incidence of hemorrhage than those with a benign presentation (4.3%), but this may be directly linked to the presence of venous ectasia.

CONCLUSION:

In this series untreated dural arteriovenous fistulae with cortical venous reflux had a 13% annual incidence of hemorrhage after diagnosis. There was a significant difference between those with and without venous ectasia. This should be confirmed by further studies, but probably defines a high-risk subgroup of patients that requires rapid intervention.

PMID:
21822156
DOI:
10.1227/NEU.0b013e318230966f
[Indexed for MEDLINE]

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