Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas
- 1 November 2009
- journal article
- case report
- Published by Journal of Neurosurgery Publishing Group (JNSPG) in Journal of Neurosurgery
- Vol. 111 (5), 889-899
- https://doi.org/10.3171/2009.1.jns08840
Abstract
Dural arteriovenous fistulas (DAVFs) with leptomeningeal venous reflux generally pose a high risk of aggressive manifestations including hemorrhage. Among DAVFs, there is a peculiar type that demonstrates direct drainage into the bridging vein rather than the dural venous sinus. The purpose of this study was to investigate the characteristics of DAVFs that drain directly into the petrosal vein or the bridging vein of the medulla oblongata. Eleven consecutive cases of DAVFs that drained directly into the petrosal vein and 6 that drained directly into the bridging vein of the medulla were retrospectively reviewed. These cases were evaluated and/or treated at Hospital de Bicêtre in Paris, France, over a 27-year period. A review of previously reported cases was also performed. Both of these "extrasinusal"-type DAVFs demonstrated very similar characteristics. There was a significant male predominance (p < 0.001) for this lesion, and a significantly higher incidence of aggressive neurological manifestations including hemorrhage or venous hypertension than in DAVFs of the transverse-sigmoid or cavernous sinus (p < 0.001). This finding was considered to be attributable to leptomeningeal venous reflux. Regarding treatment, endovascular embolization (either transarterial or transvenous) is frequently difficult, and surgery may be an effective therapeutic choice in many instances. Embryologically, both the petrosal vein and the bridging vein of the medulla are cranial homologs of the spinal cord emissary bridging veins that drain the pial venous network. The authors believe that DAVFs in these locations may be included in a single category with spinal DAVFs because of their similar clinical characteristics.Keywords
This publication has 46 references indexed in Scilit:
- Dural Arteriovenous ShuntsStroke, 2008
- Intracranial dural arteriovenous fistula showing diffuse MR enhancement of the spinal cord: Case report and review of the literatureSurgical Neurology, 2002
- A tentorial dural arteriovenous fistula successfully treated with interruption of leptomeningeal venous drainage using microvascular doppler sonography: Case reportSurgical Neurology, 2001
- Dural arteriovenous shunt involving the superior petrosal sinus: presentation and treatment by transvenous embolisation via the occipital and transverse sinusesNeuroradiology, 1997
- Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.Radiology, 1995
- A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatmentJournal of Neurosurgery, 1995
- Dural Arteriovenous Fistula of the Posterior Fossa Draining into the Spinal Medullary Veins–An Unusual Cause of MyelopathyNeurosurgery, 1994
- Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological courseJournal of Neurosurgery, 1990
- Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid spaceJournal of Neurosurgery, 1984
- Super-Selective Arteriography of the External Carotid ArteryPublished by Springer Science and Business Media LLC ,1978