Neurosurgical Review

, Volume 38, Issue 2, pp 265–272 | Cite as

Cranial dural arteriovenous shunts. Part 2. The shunts of the bridging veins and leptomeningeal venous drainage

  • Gerasimos Baltsavias
  • Rahul Kumar
  • K. M. Avinash
  • Anton Valavanis
Original Article


Leptomeningeal venous drainage of cranial dural arteriovenous fistulae is the most important determinant of adverse clinical course. Factors that predispose to its occurrence have not been adequately addressed in the literature. In the present study, we investigated the relation of shunt location to the development of leptomeningeal venous drainage, with regard to the bridging veins. Angiographic data of 211 consecutive patients with cranial dural arteriovenous fistulae treated over 19 years were analyzed. Dural shunts with leptomeningeal venous drainage were found in 107 patients; of these, 71 patients had pure leptomeningeal venous drainage (Borden type 3). The angioarchitecture of the shunt, including pattern of arterial feeders, relation with the bridging veins, primary venous drainage, and venous outflow restrictions were recorded. After analysis of the 71 Borden type 3 shunts with exclusive leptomeningeal venous drainage, three patterns emerged. The commonest was the fistula engaging a bridging vein that had lost its connection to the parent sinus into which it previously drained; it was characterized by an arterial network of feeders converging onto the wall of a bridging vein, with leptomeningeal venous reflux. The other patterns were those of “isolated” sinus segment characterized by arterial feeders converging on to the wall of the dural sinus with leptomeningeal venous reflux following the opacification of the sinus and fistulae in the vicinity of the cribriform plate with two subtypes. The main angioarchitectural features of the 36 Borden type 2 shunts with mixed sinusal-cortical venous drainage were the presence of a diffuse arterial network of vessels converging onto a site in the wall of the dural sinus, with leptomeningeal venous reflux following the opacification of the sinus. In this group, four exceptions were noticed with arterial feeders converging onto a bridging vein and having a mixed venous drainage to the cortical venous system and the sinuses. We concluded that the exact location of the shunt with regard to the bridging veins is a key factor in the development of leptomeningeal venous drainage. Cranial dural arteriovenous fistulae (CDAVFs) of either Borden type 2 or 3 do not constitute a homogeneous group. The great majority of these shunts present thrombotic phenomena.


Dural arteriovenous shunt Dural arteriovenous fistula Bridging vein Leptomeningeal drainage Cortical venous reflux 



We wish to thank Professor V. Runge for his valuable comments on the manuscript and knowledgeable suggestions.

Conflict of interest

We declare that we have no conflict of interest.

Financial support



  1. 1.
    Awad IA, Little JR, Akarawi WP, Ahl J (1990) Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72(6):839–850CrossRefPubMedGoogle Scholar
  2. 2.
    Baltsavias G, Valavanis A (2014) Endovascular treatment of 170 consecutive cranial dural arteriovenous fistulae: results and complications. Neurosurg Rev 37(1):63–71CrossRefPubMedGoogle Scholar
  3. 3.
    Barnwell SL, Halbach VV, Dowd CF, Higashida RT, Hieshima GB, Wilson CB (1991) A variant of arteriovenous fistulas within the wall of dural sinuses. Results of combined surgical and endovascular therapy. J Neurosurg 74(2):199–204CrossRefPubMedGoogle Scholar
  4. 4.
    Borden JA, Wu JK, Shucart WA (1995) A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82(2):166–179CrossRefPubMedGoogle Scholar
  5. 5.
    Castaigne P, Bories J, Brunet P, Merland JJ, Meininger V (1976) Meningeal arterio-venous fistulas with cortical venous drainage. Rev Neurol 132(3):169–181PubMedGoogle Scholar
  6. 6.
    Chaudhary MY, Sachdev VP, Cho SH, Weitzner I Jr, Puljic S, Huang YP (1982) Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. AJNR Am J Neuroradiol 3(1):13–19PubMedGoogle Scholar
  7. 7.
    Cognard C, Casasco A, Toevi M, Houdart E, Chiras J, Merland JJ (1998) Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow. J Neurol Neurosurg Psychiatry 65(3):308–316CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, Chiras J, Merland JJ (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194(3):671–680CrossRefPubMedGoogle Scholar
  9. 9.
    Dagain A (2008) Junction between the great cerebral vein and the straight sinus: an anatomical, immunohistochemical and ultrastructural study on 25 human brain cadaveric dissections. Clin Anat 21:389–397CrossRefPubMedGoogle Scholar
  10. 10.
    Djindjian R, Merland JJ, Theron J (1978) Superselective arteriography of the external carotid artery. Springer, Berlin, Heidelberg, New YorkCrossRefGoogle Scholar
  11. 11.
    Duvernoy HM, Delon S, Vannson JL (1981) Cortical blood vessels of the human brain. Brain Res Bull 7(5):519–579CrossRefPubMedGoogle Scholar
  12. 12.
    Fang YB, Li Q, Yang PF, Huang QH, Zhao WY, Xu Y, Hong B, Liu JM (2013) Treatment of blood blister-like aneurysms of the internal carotid artery with stent-assisted coil embolization. Clin Neurol Neurosurg 115(7):920–925CrossRefPubMedGoogle Scholar
  13. 13.
    Gaston A, Chiras J, Bourbotte G, Leger JM, Guibert-Tranier F, Merland JJ (1984) Meningeal arteriovenous fistulae draining into cortical veins. 31 cases. J Neuroradiol 11(3):161–177PubMedGoogle Scholar
  14. 14.
    Geibprasert S, Krings T, Pereira V, Pongpech S, Piske R, Lasjaunias P (2009) Clinical characteristics of dural arteriovenous shunts in 446 patients of three different ethnicities. Interv Neuroradiol 15(4):395–400PubMedCentralPubMedGoogle Scholar
  15. 15.
    Geibprasert S, Pereira V, Krings T, Jiarakongmun P, Toulgoat F, Pongpech S, Lasjaunias P (2008) Dural arteriovenous shunts: a new classification of craniospinal epidural venous anatomical bases and clinical correlations. Stroke 39(10):2783–2794CrossRefPubMedGoogle Scholar
  16. 16.
    Houser OW, Baker HL Jr, Rhoton AL Jr, Okazaki H (1972) Intracranial dural arteriovenous malformations. Radiology 105(1):55–64CrossRefPubMedGoogle Scholar
  17. 17.
    Houser OW, Campbell JK, Campbell RJ, Sundt TM Jr (1979) Arteriovenous malformation affecting the transverse dural venous sinus–an acquired lesion. Mayo Clin Proc 54(10):651–661PubMedGoogle Scholar
  18. 18.
    Kosnik EJ, Hunt WE, Miller CA (1974) Dural arteriovenous malformations. J Neurosurg 40(3):322–329CrossRefPubMedGoogle Scholar
  19. 19.
    Lang J (1981) Klinische Anatomie des Kopfes. Neurocranium, Orbita, kraniocervikaler Übergang. Springer, Berlin-HeidelbergCrossRefGoogle Scholar
  20. 20.
    Lasjaunias P, Berenstein, A., ter Brugge, K. (2001) Surgical neuroangiography: dural arteriovenous shunts, vol 2.2. SpringerGoogle Scholar
  21. 21.
    Lasjaunias P, Chiu M, ter Brugge K, Tolia A, Hurth M, Bernstein M (1986) Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 64(5):724–730CrossRefPubMedGoogle Scholar
  22. 22.
    Mitsuhashi Y, Aurboonyawat T, Pereira VM, Geibprasert S, Toulgoat F, Ozanne A, Lasjaunias P (2009) Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas. Clinical article. J Neurosurg 111(5):889–899CrossRefPubMedGoogle Scholar
  23. 23.
    Piske RL, Lasjaunias P (1988) Extrasinusal dural arteriovenous malformations. Report of three cases. Neuroradiology 30(5):426–432CrossRefPubMedGoogle Scholar
  24. 24.
    Piton J, Guilleux MH, Guibert-Tranier F, Caille JM (1984) Fistulae of the lateral sinus. J Neuroradiol 11(3):143–159PubMedGoogle Scholar
  25. 25.
    San Millán Ruíz DGP, Rüfenacht DA, Yilmaz H, Fasel JH (2006) Anomalous intracranial drainage of the nasal mucosa: a vein of the foramen caecum? AJNR Am J Neuroradiol 27(1):129–131PubMedGoogle Scholar
  26. 26.
    Uranishi R, Nakase H, Sakaki T (1999) Expression of angiogenic growth factors in dural arteriovenous fistula. J Neurosurg 91(5):781–786CrossRefPubMedGoogle Scholar
  27. 27.
    Whitnall E (1921) The anatomy of the human orbit and accessory organs of vision. R.R. Clark, EdinburghGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Gerasimos Baltsavias
    • 1
  • Rahul Kumar
    • 1
  • K. M. Avinash
    • 1
  • Anton Valavanis
    • 1
  1. 1.Department of NeuroradiologyUniversity Hospital ZurichZurichSwitzerland

Personalised recommendations