Acta Neurochirurgica

, Volume 159, Issue 8, pp 1479–1487

Early rebleeding of intracranial dural arteriovenous fistulas after an intracranial hemorrhage

  • Jai Ho Choi
  • Kyung Il Jo
  • Keon Ha Kim
  • Pyoung Jeon
  • Je Young Yeon
  • Jong Soo Kim
  • Seung Chyul Hong
Original Article - Vascular
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Abstract

Background

The aim of this study was to evaluate the clinical and angiographic characteristics of dural arteriovenous fistulas (DAVF) presenting with intracranial hemorrhage (ICH), with a focus on early rebleeding according to the initial hemorrhage type.

Method

The clinical and radiologic features of 21 dAVFs that presented with intracranial hemorrhage were retrospectively reviewed. The hemorrhage type was classified as pure intraparenchymal hemorrhage (pIPH) and subarachnoid or subdural hemorrhage with IPH (non-pIPH).

Results

There were 13 patients with pIPH and 8 with non-pIPH. The median follow-up period was 30 months (range, 1–116 months), and the median interval from hemorrhage to treatment was 4 days (range, 0–72 days). Rebleeding occurred in 8 (38.1%) of 21 patients. Four (50%) of eight patients with non-pIPH suffered from early rebleeding within 3 days, while there was no early rebleeding in patients with pIPH. There was a significantly higher rate of early rebleeding in the non-pIPH group (p = 0.012). Angiographically, venous ectasia (p = 0.005) and direct cortical venous drainage (dCVD) (p = 0.008) showed a significantly higher proportion in the non-pIPH group than in the pIPH group.

Conclusions

DAVFs with ICH is likely to rebleed after the first hemorrhage. Thus, early treatment can be needed in all DAVFs with ICH. In addition, DAVFs that presenting with non-pIPH and containing venous ectasia or dCVD on initial angiography may have a higher risk of early rebleeding. Therefore, cautious attention and urgent treatment are necessary for these patients.

Keywords

Dural arteriovenous fistula Intracranial hemorrhage Rebleeding Subarachnoid hemorrhage Subdural hemorrhage 

Copyright information

© Springer-Verlag Wien 2017

Authors and Affiliations

  • Jai Ho Choi
    • 1
  • Kyung Il Jo
    • 2
  • Keon Ha Kim
    • 3
  • Pyoung Jeon
    • 3
  • Je Young Yeon
    • 2
  • Jong Soo Kim
    • 2
  • Seung Chyul Hong
    • 2
  1. 1.Department of NeurosurgerySeoul St. Mary’s Hospital, The Catholic University of Korea College of MedicineSeoulSouth Korea
  2. 2.Department of Neurosurgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
  3. 3.Department of Radiology, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea

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