Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion

Junichiro Satomi University of Toronto Brain Vascular Malformation Study Group, Toronto, Ontario, Canada; Department of Neurological Surgery, University of Tokushima, Japan; and Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

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 M.D.
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J. MARC C. van Dijk University of Toronto Brain Vascular Malformation Study Group, Toronto, Ontario, Canada; Department of Neurological Surgery, University of Tokushima, Japan; and Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

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 M.D.
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Karel G. Terbrugge University of Toronto Brain Vascular Malformation Study Group, Toronto, Ontario, Canada; Department of Neurological Surgery, University of Tokushima, Japan; and Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

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 M.D., F.R.C.P.(C)
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Robert A. Willinsky University of Toronto Brain Vascular Malformation Study Group, Toronto, Ontario, Canada; Department of Neurological Surgery, University of Tokushima, Japan; and Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

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M. Christopher Wallace University of Toronto Brain Vascular Malformation Study Group, Toronto, Ontario, Canada; Department of Neurological Surgery, University of Tokushima, Japan; and Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands

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Object. Cranial dural arteriovenous fistulas (DAVFs) can be classified into benign or aggressive, based on their patterns of venous drainage. A benign condition requires the absence of cortical venous drainage (CVD). The clinical and angiographic features of a consecutive single-center group of 117 patients harboring benign cranial DAVFs were evaluated over time to validate the behavior and appropriate management of these lesions.

Methods. At the initial assessment four patients were asymptomatic. Two infants presented with congestive heart failure. All other patients presented with other benign symptoms: chronic headache, bruit, or orbital phenomena. Observational management was instituted in 73 patients (62%). Intolerable bruit or ophthalmological sequelae were deemed indications for palliative embolization in 43 patients and surgical treatment in one patient. A median follow-up period of 27.9 months (range 1 month—17.5 years) was available in 112 patients (95.7%), among whom repeated angiography was performed in 50. Overall, observational and palliative management resulted in a benign and tolerable level of disease in 110 (98.2%) of 112 cases. In two cases managed conservatively CVD developed. In both of these cases the conversion from benign to aggressive DAVF was associated with spontaneous progressive thrombosis of venous outlets.

Conclusions. The disease course of a cranial DAVF without CVD is indeed benign, obviating the need for a cure of these lesions. Symptoms are well tolerated with either observation or palliative treatment. After a long-term follow-up review of 68 patients, this conservative management resulted in a benign and tolerable level of disease in 98.5% of cases. It is noteworthy, however, that a benign DAVF carries a 2% risk of developing CVD, mandating close clinical follow-up review in such cases and renewed radiological evaluation in response to any deterioration in the patient's condition.

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  • 1.

    Awad IA, , Little JR, & Akarawi WP, et al: Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72:839850, 1990 Awad IA, Little JR, Akarawi WP, et al: Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72:839–850, 1990

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Borden JA, , Wu JK, & Shucart WA: A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82:166179, 1995 Borden JA, Wu JK, Shucart WA: A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82:166–179, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Brown RD Jr, , Wiebers DO, & Nichols DA: Intracranial dural arteriovenous fistulae: angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients. J Neurosurg 81:531538, 1994 Brown RD Jr, Wiebers DO, Nichols DA: Intracranial dural arteriovenous fistulae: angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients. J Neurosurg 81:531–538, 1994

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Chaudhary MY, , Sachdev VP, & Cho SH, et al: Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. AJNR 3:1319, 1982 Chaudhary MY, Sachdev VP, Cho SH, et al: Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. AJNR 3:13–19, 1982

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Cognard C, , Casasco A, & Toevi M, et al: Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow. J Neurol Neurosurg Psychiatry 65:308316, 1998 Cognard C, Casasco A, Toevi M, et al: Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow. J Neurol Neurosurg Psychiatry 65:308–316, 1998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Cognard C, , Gobin YP, & Pierot L, et al: Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194:671680, 1995 Cognard C, Gobin YP, Pierot L, et al: Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194:671–680, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Cognard C, , Houdart E, & Casasco A, et al: Long-term changes in intracranial dural arteriovenous fistulae leading to worsening in the type of venous drainage. Neuroradiology 39:5966, 1997 Cognard C, Houdart E, Casasco A, et al: Long-term changes in intracranial dural arteriovenous fistulae leading to worsening in the type of venous drainage. Neuroradiology 39:59–66, 1997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Davies MA, , Saleh J, & ter Brugge K, et al: The natural history and management of intracranial dural arteriovenous fistulae. Part 1: Benign lesions. Interv Neuroradiol 3:295302, 1997 Davies MA, Saleh J, ter Brugge K, et al: The natural history and management of intracranial dural arteriovenous fistulae. Part 1: Benign lesions. Interv Neuroradiol 3:295–302, 1997

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Davies MA, , TerBrugge K, & Willinsky R, et al: The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 85:830837, 1996 Davies MA, TerBrugge K, Willinsky R, et al: The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 85:830–837, 1996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Fermand M, , Reizine D, & Melki JP, et al: Long term follow-up of 43 pure dural arteriovenous fistulae (AVF) of the lateral sinus. Neuroradiology 29:348353, 1987 Fermand M, Reizine D, Melki JP, et al: Long term follow-up of 43 pure dural arteriovenous fistulae (AVF) of the lateral sinus. Neuroradiology 29:348–353, 1987

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Gelwan MJ, , Choi IS, & Berenstein A, et al: Dural arteriovenous malformations and papilledema. Neurosurgery 22:10791084, 1988 Gelwan MJ, Choi IS, Berenstein A, et al: Dural arteriovenous malformations and papilledema. Neurosurgery 22:1079–1084, 1988

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Herman JM, , Spetzler RF, & Bederson JB, et al: Genesis of a dural arteriovenous malformation in a rat model. J Neurosurg 83:539545, 1995 Herman JM, Spetzler RF, Bederson JB, et al: Genesis of a dural arteriovenous malformation in a rat model. J Neurosurg 83:539–545, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Houser OW, , Baker HL Jr, & Rhoton AL Jr, et al: Intracranial dural arteriovenous malformations. Radiology 105:5564, 1972 Houser OW, Baker HL Jr, Rhoton AL Jr, et al: Intracranial dural arteriovenous malformations. Radiology 105:55–64, 1972

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Houser OW, , Campbell JK, & Campbell RJ, et al: Arteriovenous malformation affecting the transverse dural venous sinus—an acquired lesion. Mayo Clin Proc 54:651661, 1979 Houser OW, Campbell JK, Campbell RJ, et al: Arteriovenous malformation affecting the transverse dural venous sinus—an acquired lesion. Mayo Clin Proc 54:651–661, 1979

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Hurst RW, , Bagley LJ, & Galetta S, et al: Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy. AJNR 19:12671273, 1998 Hurst RW, Bagley LJ, Galetta S, et al: Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy. AJNR 19:1267–1273, 1998

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Kataoka K, & Taneda M: Angiographic disappearance of multiple dural arteriovenous malformations. Case report. J Neurosurg 60:12751278, 1984 Kataoka K, Taneda M: Angiographic disappearance of multiple dural arteriovenous malformations. Case report. J Neurosurg 60:1275–1278, 1984

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Lalwani AK, , Dowd CF, & Halbach VV: Grading venous restrictive disease in patients with dural arteriovenous fistulas of the transverse/sigmoid sinus. J Neurosurg 79:1115, 1993 Lalwani AK, Dowd CF, Halbach VV: Grading venous restrictive disease in patients with dural arteriovenous fistulas of the transverse/sigmoid sinus. J Neurosurg 79:11–15, 1993

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Lasjaunias P, , Chiu M, & ter Brugge K, et al: Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 64:724730, 1986 Lasjaunias P, Chiu M, ter Brugge K, et al: Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 64:724–730, 1986

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Luciani A, , Houdart E, & Mounayer C, et al: Spontaneous closure of dural arteriovenous fistulas: report of three cases and review of the literature. AJNR 22:992996, 2001 Luciani A, Houdart E, Mounayer C, et al: Spontaneous closure of dural arteriovenous fistulas: report of three cases and review of the literature. AJNR 22:992–996, 2001

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Malik GM, , Pearce JE, & Ausman JI, et al: Dural arteriovenous malformations and intracranial hemorrhage. Neurosurgery 15:332339, 1984 Malik GM, Pearce JE, Ausman JI, et al: Dural arteriovenous malformations and intracranial hemorrhage. Neurosurgery 15:332–339, 1984

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Mullan S, & Johnson DL: Combined sagittal and lateral sinus dural fistulae occlusion. J Neurosurg 82:159165, 1995 Mullan S, Johnson DL: Combined sagittal and lateral sinus dural fistulae occlusion. J Neurosurg 82:159–165, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Nishijima M, , Takaku A, & Endo S, et al: Etiological evaluation of dural arteriovenous malformations of the lateral and sigmoid sinuses based on histopathological examinations. J Neurosurg 76:600606, 1992 Nishijima M, Takaku A, Endo S, et al: Etiological evaluation of dural arteriovenous malformations of the lateral and sigmoid sinuses based on histopathological examinations. J Neurosurg 76:600–606, 1992

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Piton J, , Guilleux MH, & Guibert-Tranier F, et al: [Fistulae of the lateral sinus.] J Neuroradiol 11:143159, 1984 (Fr) Piton J, Guilleux MH, Guibert-Tranier F, et al: [Fistulae of the lateral sinus.] J Neuroradiol 11:143–159, 1984 (Fr)

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Terada T, , Higashida RT, & Halbach VV, et al: Development of acquired arteriovenous fistulas in rats due to venous hypertension. J Neurosurg 80:884889, 1994 Terada T, Higashida RT, Halbach VV, et al: Development of acquired arteriovenous fistulas in rats due to venous hypertension. J Neurosurg 80:884–889, 1994

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Uranishi R, , Nakase H, & Sakaki T: Expression of angiogenic growth factors in dural arteriovenous fistula. J Neurosurg 91:781786, 1999 Uranishi R, Nakase H, Sakaki T: Expression of angiogenic growth factors in dural arteriovenous fistula. J Neurosurg 91:781–786, 1999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Willinsky R, , Goyal M, & terBrugge K, et al: Tortuous, engorged pial veins in intracranial dural arteriovenous fistulas: correlations with presentation, location, and MR findings in 122 patients. AJNR 20:10311036, 1999 Willinsky R, Goyal M, terBrugge K, et al: Tortuous, engorged pial veins in intracranial dural arteriovenous fistulas: correlations with presentation, location, and MR findings in 122 patients. AJNR 20:1031–1036, 1999

    • PubMed
    • Search Google Scholar
    • Export Citation

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