Dural arteriovenous malformations

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✓ The history, physical findings, and treatment of dural arteriovenous malformations are reviewed. The importance of completely identifying and obliterating the fistula, even at the expense of obliterating major venous sinuses, is emphasized. Failure of surgical treatment usually is the result of mistaking the more obvious dilated feeding vessels for the lesion itself.

Article Information

Address reprint requests to: Edward J. Kosnik, M.D., Division of Neurological Surgery, Ohio State University Hospitals, Columbus, Ohio 43210.

© AANS, except where prohibited by US copyright law.

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Figures

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    Case 1. Vertebral angiogram demonstrating a fistula (arrow) between the external branches of the vertebral artery and lateral sinus with early filling of the jugular vein.

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    Case 2. Early films in the initial angiogram demonstrating filling of the superior sagittal sinus directly from branches of the external carotid arteries (arrows). Note that the anterior circulation is still in the arterial phase and that there has been no compensatory dilatation of arterial vessels.

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    Case 2. Later films demonstrating reversal of blood flow in the sagittal sinus and cortical veins. The cortical vein dilatation is secondary and not part of the malformation.

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    Case 2. Vertebral angiogram before the second procedure demonstrating early shunting into the lateral sinus. Arrows demonstrate an enlarged branch of vertebral system draining into the lateral sinus.

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    Case 2. Selective costocervical trunk injection demonstrating extensive flow from the external carotid vessels into the sagittal and left lateral sinuses.

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    Case 2. Angiogram prior to the third procedure demonstrating persistence of the fistula after obliteration of the left lateral sinus.

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    Case 2. Final angiogram after total excision of the torcular Herophili, posterior falx, and tentorium up to the vein of Galen, demonstrating normally timed circulation.

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    Case 3. Left carotid angiogram demonstrating an AVM of the falx cerebri fed by branches of the calloso-marginal artery (open arrow) and hypertrophied anterior meningeal branch of external carotid system (solid arrow). Note early filling of the inferior sagittal sinus.

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