Neurological manifestations of intracranial dural arteriovenous malformations

Pierre Lasjaunias M.D., Ph.D. 1 , Ming Chiu M.D., F.R.C.P. 1 , Karel Ter Brugge M.D., F.R.C.P. 1 , Atul Tolia M.D., F.R.C.P. 1 , Michel Hurth M.D. 1 and Mark Bernstein M.D. 1
View More View Less
  • 1 Departments of Radiology and Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada, and Radiology and Neurosurgery Services, Hôpital Bicetre, le Kremlin Bicetre, France
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ The authors describe their experience with four cases of dural arteriovenous malformation (AVM) which led them to analyze the clinical aspects of these lesions in an attempt to understand their pathophysiology. An additional 191 previously reported cases of dural AVM's were reviewed with special attention to the mechanism of intradural, central, and peripheral nervous system manifestations. Apart from the peripheral cranial nerve symptoms, which are most likely due to arterial steal, the central nervous system (CNS) symptoms appear to be related to passive venous hypertension and/or congestion. Generalized CNS symptoms can be related to cerebrospinal fluid malabsorption due either to increased pressure in the superior sagittal sinus, to venous sinus thrombosis, or to meningeal reaction resulting from minimal subarachnoid hemorrhages. These phenomena are not related to the anatomical type of venous drainage. On the other hand, focal CNS symptoms are specifically indicative of cortical venous drainage. Seizures, transient ischemic attacks, motor weakness, and brain-stem and cerebellar symptoms can be encountered depending on the territory of the draining vein or veins. Therefore, the localizing value of focal CNS symptomatology relates to the venous territory and not to the nidus or to the arterial supply characteristics of dural AVM's. Furthermore, the venous patterns of various dural AVM's at the base of the skull are expressed by differences in their clinical presentation. Dural AVM's of the floor of the anterior cranial fossa and of the tentorium are almost always drained by the cortical veins and, therefore, have a high risk of intradural bleeding.

The remarkable similarities in the manifestations of dural and brain AVM's and the differences in the manifestations of dural and spinal dural AVM's are pointed out. High-quality angiograms and a multidisciplinary approach to the study of dural AVM's will provide the best understanding of their symptoms and, therefore, the most appropriate treatment strategy.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Pierre Lasjaunias, M.D., Department of Radiology, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8.
  • 1.

    Albright AL, , Latchaw RE, & Price RA: Posterior dural arteriovenous malformation in infancy. Neurosurgery 13:129135, 1983 Albright AL, Latchaw RE, Price RA: Posterior dural arteriovenous malformation in infancy. Neurosurgery 13:129–135, 1983

    • Search Google Scholar
    • Export Citation
  • 2.

    Aminoff MJ: Vascular anomalies in the intracranial dura mater. Brain 96:601612, 1973 Aminoff MJ: Vascular anomalies in the intracranial dura mater. Brain 96:601–612, 1973

    • Search Google Scholar
    • Export Citation
  • 3.

    Brismar G, & Brismar J: Spontaneous carotid-cavernous fistulas. Phlebographic appearance and relation to thrombosis. Acta Radiol (Diagn) 17:180192, 1976 Brismar G, Brismar J: Spontaneous carotid-cavernous fistulas. Phlebographic appearance and relation to thrombosis. Acta Radiol (Diagn) 17:180–192, 1976

    • Search Google Scholar
    • Export Citation
  • 4.

    Castaigne P, , Bories J, & Brunet P, et al: Les fistules artérioveineuses méningées pures à drainage veineux cortical. Rev Neurol 132:169181, 1976 Castaigne P, Bories J, Brunet P, et al: Les fistules artérioveineuses méningées pures à drainage veineux cortical. Rev Neurol 132:169–181, 1976

    • Search Google Scholar
    • Export Citation
  • 5.

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

    • Search Google Scholar
    • Export Citation
  • 6.

    Debrun G, & Chartres A: Infra and supratentorial arteriovenous malformations. A general review about two cases of spontaneous supratentorial arteriovenous malformation of the dura. Neuroradiology 3:184192, 1972 Debrun G, Chartres A: Infra and supratentorial arteriovenous malformations. A general review about two cases of spontaneous supratentorial arteriovenous malformation of the dura. Neuroradiology 3:184–192, 1972

    • Search Google Scholar
    • Export Citation
  • 7.

    Djindjian R, , Cophignon J, & Comoy J, et al: Polymorphisme neuro-radiologique des fistules carotido-caverneuses. Neurochirurgie 14:881890, 1968 Djindjian R, Cophignon J, Comoy J, et al: Polymorphisme neuro-radiologique des fistules carotido-caverneuses. Neurochirurgie 14:881–890, 1968

    • Search Google Scholar
    • Export Citation
  • 8.

    Djindjian R, , Manelfe C, & Picard L: Fistules artério-veineuses carotide externe-sinus caverneux. Etude angiographique à propos de 6 observations et revue de la littérature. Neurochirurgie 19:91110, 1973 Djindjian R, Manelfe C, Picard L: Fistules artério-veineuses carotide externe-sinus caverneux. Etude angiographique à propos de 6 observations et revue de la littérature. Neurochirurgie 19:91–110, 1973

    • Search Google Scholar
    • Export Citation
  • 9.

    Djindjian R, & Merland JJ: Superselective Arteriography of the External Carotid Artery. Berlin/Heidelberg/New York: Springer-Verlag, 1978 Djindjian R, Merland JJ: Superselective Arteriography of the External Carotid Artery. Berlin/Heidelberg/New York: Springer-Verlag, 1978

    • Search Google Scholar
    • Export Citation
  • 10.

    Dora F, & Zileli T: Common variations of the lateral and occipital sinuses at the confluens sinuum. Neuroradiology 20:2327, 1980 Dora F, Zileli T: Common variations of the lateral and occipital sinuses at the confluens sinuum. Neuroradiology 20:23–27, 1980

    • Search Google Scholar
    • Export Citation
  • 11.

    Fincher EF: Arteriovenous fistula between the middle meningeal artery and the greater petrosal sinus. Case report. Ann Surg 133:886888, 1951 Fincher EF: Arteriovenous fistula between the middle meningeal artery and the greater petrosal sinus. Case report. Ann Surg 133:886–888, 1951

    • Search Google Scholar
    • Export Citation
  • 12.

    Grisoli F, , Vincentelli F, & Fuchs S, et al: Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space. Report of four cases. J Neurosurg 60:10591066, 1984 Grisoli F, Vincentelli F, Fuchs S, et al: Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space. Report of four cases. J Neurosurg 60:1059–1066, 1984

    • Search Google Scholar
    • Export Citation
  • 13.

    Gürsoy G, , Tolun R, & Bahar S: Aneurysmal dilatation of torcula. Neuroradiology 18:285288, 1979 Gürsoy G, Tolun R, Bahar S: Aneurysmal dilatation of torcula. Neuroradiology 18:285–288, 1979

    • Search Google Scholar
    • Export Citation
  • 14.

    Hayes GJ: External carotid-cavernous sinus fistulas. J Neurosurg 20:692700, 1963 Hayes GJ: External carotid-cavernous sinus fistulas. J Neurosurg 20:692–700, 1963

    • Search Google Scholar
    • Export Citation
  • 15.

    Hieshima G, , Cahan LD, & Berlin MS, et al: Calvarial, orbital and dural vascular anomalies in hereditary hemorrhagic telangiectasia. Surg Neurol 8:263267, 1977 Hieshima G, Cahan LD, Berlin MS, et al: Calvarial, orbital and dural vascular anomalies in hereditary hemorrhagic telangiectasia. Surg Neurol 8:263–267, 1977

    • Search Google Scholar
    • Export Citation
  • 16.

    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

    • Search Google Scholar
    • Export Citation
  • 17.

    Ito J, , Imamura H, & Kobayashi K, et al: Dural arteriovenous malformations of the base of the anterior cranial fossa. Neuroradiology 24:149154, 1983 Ito J, Imamura H, Kobayashi K, et al: Dural arteriovenous malformations of the base of the anterior cranial fossa. Neuroradiology 24:149–154, 1983

    • Search Google Scholar
    • Export Citation
  • 18.

    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

    • Search Google Scholar
    • Export Citation
  • 19.

    Kosnik EJ, , Hunt WE, & Miller CA: Dural arteriovenous malformations. J Neurosurg 40:322329, 1974 Kosnik EJ, Hunt WE, Miller CA: Dural arteriovenous malformations. J Neurosurg 40:322–329, 1974

    • Search Google Scholar
    • Export Citation
  • 20.

    Kühner A, , Krastel A, & Stoll W: Arteriovenous malformations of the transverse dural sinus. J Neurosurg 45:1219, 1976 Kühner A, Krastel A, Stoll W: Arteriovenous malformations of the transverse dural sinus. J Neurosurg 45:12–19, 1976

    • Search Google Scholar
    • Export Citation
  • 21.

    Laine E, , Galibert P, & Lopez C, et al: Anevrysmes artérioveineux intra-duraux (développés dans l'épaisseur de la dure-mére) de la fosse postérieure. Neurochirurgie 9:147158, 1963 Laine E, Galibert P, Lopez C, et al: Anevrysmes artérioveineux intra-duraux (développés dans l'épaisseur de la dure-mére) de la fosse postérieure. Neurochirurgie 9:147–158, 1963

    • Search Google Scholar
    • Export Citation
  • 22.

    Lamas E, , Lobato RD, & Esparza J, et al: Dural posterior fossa AVM producing raised sagittal sinus pressure. Case report. J Neurosurg 46:804810, 1977 Lamas E, Lobato RD, Esparza J, et al: Dural posterior fossa AVM producing raised sagittal sinus pressure. Case report. J Neurosurg 46:804–810, 1977

    • Search Google Scholar
    • Export Citation
  • 23.

    Lapresle J, & Lasjaunias P: Cranial nerve ischaemic arterial syndromes. A review. Brain (In press, 1986)Lapresle J, Lasjaunias P: Cranial nerve ischaemic arterial syndromes. A review. Brain (In press, 1986)

    • Search Google Scholar
    • Export Citation
  • 24.

    Lasjaunias P, & Berenstein A: Craniofacial and Upper Cervical Arteries: Collateral Circulation and Angiographic Protocols. Baltimore: Williams & Wilkins, 1981 Lasjaunias P, Berenstein A: Craniofacial and Upper Cervical Arteries: Collateral Circulation and Angiographic Protocols. Baltimore: Williams & Wilkins, 1981

    • Search Google Scholar
    • Export Citation
  • 25.

    Lasjaunias P, & Berenstein A: Craniofacial and Upper Cervical Arteries. Functional, Clinical and Angiographic Aspects. Baltimore: Williams & Wilkins, 1983 Lasjaunias P, Berenstein A: Craniofacial and Upper Cervical Arteries. Functional, Clinical and Angiographic Aspects. Baltimore: Williams & Wilkins, 1983

    • Search Google Scholar
    • Export Citation
  • 26.

    Lasjaunias P, , Halimi P, & Lopez-Ibor L, et al: Traitement endovasculaire des malformations vasculaires durales (MVD) pures “spontanées.” Revue de 23 cas explorés et traités entre mai 1980 et octobre 1983. Neurochirurgie 30:207223, 1984 Lasjaunias P, Halimi P, Lopez-Ibor L, et al: Traitement endovasculaire des malformations vasculaires durales (MVD) pures “spontanées.” Revue de 23 cas explorés et traités entre mai 1980 et octobre 1983. Neurochirurgie 30:207–223, 1984

    • Search Google Scholar
    • Export Citation
  • 27.

    Lepoire J, , Montaut J, & Bouchot M, et al: Anevrysmes artério-veineux intrafrontaux vascularisés par l'artère ethomoïdale antérieure. A propos de trois observations. Neurochirurgie 9:159166, 1963 Lepoire J, Montaut J, Bouchot M, et al: Anevrysmes artério-veineux intrafrontaux vascularisés par l'artère ethomoïdale antérieure. A propos de trois observations. Neurochirurgie 9:159–166, 1963

    • Search Google Scholar
    • Export Citation
  • 28.

    Miyasaka K, , Takei H, & Nomura M, et al: Computerized tomography findings in dural arteriovenous malformations. Report of three cases. J Neurosurg 53:698702, 1980 Miyasaka K, Takei H, Nomura M, et al: Computerized tomography findings in dural arteriovenous malformations. Report of three cases. J Neurosurg 53:698–702, 1980

    • Search Google Scholar
    • Export Citation
  • 29.

    Newton TH, & Cronqvist S: Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93:10711078, 1969 Newton TH, Cronqvist S: Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93:1071–1078, 1969

    • Search Google Scholar
    • Export Citation
  • 30.

    Newton TH, & Hoyt WF: Dural arteriovenous shunts in the region of the cavernous sinus. Neuroradiology 1:7181, 1970 Newton TH, Hoyt WF: Dural arteriovenous shunts in the region of the cavernous sinus. Neuroradiology 1:71–81, 1970

    • Search Google Scholar
    • Export Citation
  • 31.

    Newton TH, , Weidner W, & Greitz T: Dural arteriovenous malformation in the posterior fossa. Radiology 90:2735, 1968 Newton TH, Weidner W, Greitz T: Dural arteriovenous malformation in the posterior fossa. Radiology 90:27–35, 1968

    • Search Google Scholar
    • Export Citation
  • 32.

    Obrador S, , Soto M, & Silvela J: Clinical syndromes of arteriovenous malformations of the transverse-sigmoid sinus. J Neurol Neurosurg Psychiatry 38:436451, 1975 Obrador S, Soto M, Silvela J: Clinical syndromes of arteriovenous malformations of the transverse-sigmoid sinus. J Neurol Neurosurg Psychiatry 38:436–451, 1975

    • Search Google Scholar
    • Export Citation
  • 33.

    Olutola PS, , Eliam M, & Molot M, et al: Spontaneous regression of a dural arteriovenous malformation. Neurosurgery 12:687690, 1983 Olutola PS, Eliam M, Molot M, et al: Spontaneous regression of a dural arteriovenous malformation. Neurosurgery 12:687–690, 1983

    • Search Google Scholar
    • Export Citation
  • 34.

    Pecker J, , Bonnal J, & Javalet A: Deux nouveaux cas d'anévrysmes artério-veineux intraduraux de la fosse postérieure alimentés par la carotide externe. Neurochirurgie 11:327332, 1965 Pecker J, Bonnal J, Javalet A: Deux nouveaux cas d'anévrysmes artério-veineux intraduraux de la fosse postérieure alimentés par la carotide externe. Neurochirurgie 11:327–332, 1965

    • Search Google Scholar
    • Export Citation
  • 35.

    Robinson JL, & Sedzimir CB: External carotid-transverse sinus fistula. Case report. J Neurosurg 33:718720, 1970 Robinson JL, Sedzimir CB: External carotid-transverse sinus fistula. Case report. J Neurosurg 33:718–720, 1970

    • Search Google Scholar
    • Export Citation
  • 36.

    Sundt TM Jr, & Piepgras DG: The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg 59:3239, 1983 Sundt TM Jr, Piepgras DG: The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg 59:32–39, 1983

    • Search Google Scholar
    • Export Citation
  • 37.

    Terada T, , Kikuchi H, & Karasawa J, et al: Intracerebral arteriovenous malformation fed by the anterior ethmoidal artery: case report. Neurosurgery 14:578582, 1984 Terada T, Kikuchi H, Karasawa J, et al: Intracerebral arteriovenous malformation fed by the anterior ethmoidal artery: case report. Neurosurgery 14:578–582, 1984

    • Search Google Scholar
    • Export Citation
  • 38.

    Turner DM, , Vangilder JC, & Mojtahedi S, et al: Spontaneous intracerebral hematoma in carotid-cavernous fistula. Report of three cases. J Neurosurg 59:680686, 1983 Turner DM, Vangilder JC, Mojtahedi S, et al: Spontaneous intracerebral hematoma in carotid-cavernous fistula. Report of three cases. J Neurosurg 59:680–686, 1983

    • Search Google Scholar
    • Export Citation
  • 39.

    van der Werf AJM: Sur un cas d'anévrisme artérioveineux intradural bilatéral de la fosse postérieure chez un enfant. Neurochirurgie 10:140144, 1964 van der Werf AJM: Sur un cas d'anévrisme artérioveineux intradural bilatéral de la fosse postérieure chez un enfant. Neurochirurgie 10:140–144, 1964

    • Search Google Scholar
    • Export Citation
  • 40.

    Viñuela F, , Fox AJ, & Debrun GM, et al: Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases. J Neurosurg 60:976984, 1984 Viñuela F, Fox AJ, Debrun GM, et al: Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases. J Neurosurg 60:976–984, 1984

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1055 294 32
Full Text Views 378 38 0
PDF Downloads 181 31 0
EPUB Downloads 0 0 0