, Volume 61, Issue 5, pp 613–620 | Cite as

Drainage outflow restriction as a parameter associated with cortical venous reflux in craniofacial arteriovenous malformations with cavernous sinus drainage

  • I-Chang Su
  • Chih-Ju Chang
  • Ming-Hong Chen
  • Shih-Lun Lo
  • Jui-Pin Chao
  • Ming-Ting Chen
  • Jian-Jr LeeEmail author
Interventional Neuroradiology



Craniofacial arteriovenous malformations (CF-AVMs) are locally aggressive extracranial lesions. When CF-AVMs involve cavernous sinus (CS) as their draining vein, they represent a special subgroup which may interfere intracranial venous system. In this study, we aimed to analyze the venous drainage patterns of CF-AVMs with CS drainage and to demonstrate how it affected our treatment strategy.


Cases of CF-AVMs associated with CS drainage were collected from a prospectively collected database of patients with CF-AVMs who underwent endovascular treatment from September 2016 to March 2018. Clinical data and angioarchitectural findings were analyzed. Factors associated with the presence of venous reflux (cortical venous reflux (CVR) or dural sinus reflux (DSR)) were analyzed.


Fifteen CF-AVM patients associated with CS drainage were analyzed. Three cases of venous reflux from the CS were identified (CVR, 2; DSR, 1). Lesions with unilateral venous drainage, ≤ 2 draining veins, and the absence of antegrade CS outflow were more likely to develop venous reflux from the CS. We successfully performed additional trans-venous coil embolization of the superior ophthalmic vein in two patients with malformations associated with venous reflux to close this venous connection to the CS.


CF-AVMs associated with CS drainage confer an increased risk of CVR and DSR, especially in cases where the drainage outflow is restricted. Identification of this venous angioarchitecture is essential in the evaluation and treatment planning of CF-AVMs.


Arteriovenous malformations Craniofacial Cavernous sinus Embolization Venous reflux 



This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this retrospective study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Medicine, College of MedicineFu Jen Catholic UniversityNew TaipeiTaiwan
  2. 2.Division of Neurosurgery, Department of SurgeryTaipei Cathay General HospitalTaipeiTaiwan
  3. 3.Division of Plastic Surgery, Department of SurgeryTaipei Cathay General HospitalTaipeiTaiwan
  4. 4.Division of SurgeryChi-Mei Medical CenterTainanTaiwan
  5. 5.Division of Plastic Surgery, Department of SurgeryNational Taiwan University HospitalTaipeiTaiwan

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