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Venous angioarchitectural features of intracranial dural arteriovenous shunt and its relation to the clinical course

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

The aim of this study is to assess the relationship between the venous angioarchitectural features and the clinical course of intracranial dural arteriovenous shunt (DAVS) with cortical venous reflux (CVR).

Methods

With institutional review board approval, 41 patients (M:F = 24:17; median age, 52 years (range, 1–72 years), median follow-up; 1.5 years; partial treatment, n = 36) with persistent CVR were included. We evaluated the initial presentation and the incidence of annual morbidity (hemorrhage or new/worsened nonhemorrhagic neurological deficit (NHND)) according to the venous angiographic patterns—isolated venous sinus, occlusion of the draining sinus, direct pial venous drainage, pseudophlebitic pattern, venous ectasia, brisk venous drainage, and length of pial vein reflux—on digital subtraction angiography. Cox regression was performed to identify independent factors for clinical course.

Results

During 111.9 patient-years of follow-up, the overall annual morbidity rate was 11.6 % (mortality; n = 3, rate; 2.6 %/year). Hemorrhage occurred in five patients (12.2 %, rate; 4.5 %/year) and new/worsened NHND occurred in eight patients (19.5 %, rate; 7.2 %/year). Patients with isolated venous sinus, direct pial venous drainage, and pseudophlebitic pattern were associated with initial aggressive presentation. Venous ectasia was associated with initial hemorrhagic presentation. Brisk venous drainage was associated with initial benign presentation. Patients with isolated venous sinus showed a poor clinical course with a higher annual incidence of hemorrhage or new/worsened NHND (91.2 %/year vs 9.2 %/year; hazard ratio, 6.681; p = 0.027).

Conclusions

Venous angioarchitectural features may be predictive of the clinical course of DAVSs. DAVS patients with isolated venous sinus may be especially at high risk for future aggressive clinical course.

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Acknowledgment

This study was supported by a faculty research grant of Yonsei University College of Medicine for 2010 (6-2010-0150).

Conflict of interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-ku, Seoul, 120-752, Korea

    Na-Young Shin, Young Sub Kwon, Sam Yeol Ha, Byung Moon Kim, Dong Ik Kim & Dong Joon Kim

  2. Department of Neurosurgery, Myongji Hospital, Kwandong University College of Medicine, Gyeonggi-do, Korea

    Young Sub Kwon

  3. Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea

    Sam Yeol Ha

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  1. Na-Young Shin
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  2. Young Sub Kwon
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  3. Sam Yeol Ha
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  5. Dong Ik Kim
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Correspondence to Dong Joon Kim.

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Shin, NY., Kwon, Y.S., Ha, S.Y. et al. Venous angioarchitectural features of intracranial dural arteriovenous shunt and its relation to the clinical course. Neuroradiology 55, 1119–1127 (2013). https://doi.org/10.1007/s00234-013-1222-1

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  • DOI: https://doi.org/10.1007/s00234-013-1222-1

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