Jai Ho Choi1, Kyung Il Jo2, Keon Ha Kim3, Pyoung Jeon4, Je Young Yeon2, Jong Soo Kim2, Seung Chyul Hong2. 1. Department of Neurosurgery, Bundang Jesaeng Hospital, Sungnam, Korea. 2. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 3. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, Republic of Korea. 4. Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, Republic of Korea. drpjeon@gmail.com.
Abstract
INTRODUCTION: We evaluated the relationship between symptomatic and angiographic changes in untreated cavernous sinus dural arteriovenous fistulas (CSdAVFs), focusing on venous drainage patterns. METHODS: The clinical and radiologic features of 34 cases of untreated CSdAVF were retrospectively reviewed. We classified venous drainage patterns as type I (only antegrade drainage), type II (combined antegrade drainage and venous reflux), type III (venous reflux without antegrade drainage), or type IV (stasis or occlusion of venous reflux). Symptom changes were categorized as improvement, aggravation of initial symptoms, or symptom pattern change. RESULTS: Twenty-one patients (61 %) showed symptom changes during follow-up (median, 12; range, 3-151 months). In the symptom improvement group (n = 10), patients who underwent follow-up angiography (n = 4) exhibited spontaneous occlusion. In the symptom aggravation group (n = 4), new venous reflux developed in 2 patients (type I to type II) and spontaneous occlusion in 2 patients (type III to spontaneous occlusion). In the symptom pattern change group (n = 7), 2 patients showed new venous reflux (type I to type II), and 5 showed stasis or occlusion of an engorged ophthalmic vein (type II or III to type IV). Angiographic regression was observed in all type III and IV patients, and cortical venous reflux (CVR) developed in 1 type I patient. CONCLUSION: Symptom changes correlated with chronological angiographic changes. Without treatment, most CSdAVFs behaved benignly and had a low incidence of CVR. Therefore, close observation is a possible protocol for managing CSdAVFs that have tolerable symptoms, no CVR, and no antegrade drainage despite aggravation or fluctuation in symptoms.
INTRODUCTION: We evaluated the relationship between symptomatic and angiographic changes in untreated cavernous sinus dural arteriovenous fistulas (CSdAVFs), focusing on venous drainage patterns. METHODS: The clinical and radiologic features of 34 cases of untreated CSdAVF were retrospectively reviewed. We classified venous drainage patterns as type I (only antegrade drainage), type II (combined antegrade drainage and venous reflux), type III (venous reflux without antegrade drainage), or type IV (stasis or occlusion of venous reflux). Symptom changes were categorized as improvement, aggravation of initial symptoms, or symptom pattern change. RESULTS: Twenty-one patients (61 %) showed symptom changes during follow-up (median, 12; range, 3-151 months). In the symptom improvement group (n = 10), patients who underwent follow-up angiography (n = 4) exhibited spontaneous occlusion. In the symptom aggravation group (n = 4), new venous reflux developed in 2 patients (type I to type II) and spontaneous occlusion in 2 patients (type III to spontaneous occlusion). In the symptom pattern change group (n = 7), 2 patients showed new venous reflux (type I to type II), and 5 showed stasis or occlusion of an engorged ophthalmic vein (type II or III to type IV). Angiographic regression was observed in all type III and IV patients, and cortical venous reflux (CVR) developed in 1 type I patient. CONCLUSION: Symptom changes correlated with chronological angiographic changes. Without treatment, most CSdAVFs behaved benignly and had a low incidence of CVR. Therefore, close observation is a possible protocol for managing CSdAVFs that have tolerable symptoms, no CVR, and no antegrade drainage despite aggravation or fluctuation in symptoms.
Authors: H Sasaki; H Nukui; M Kaneko; S Mitsuka; T Hosaka; T Kakizawa; R Kimura; Y Nagaseki; H Naganuma Journal: Acta Neurochir (Wien) Date: 1988 Impact factor: 2.216
Authors: Junichiro Satomi; J Marc C van Dijk; Karel G Terbrugge; Robert A Willinsky; M Christopher Wallace Journal: J Neurosurg Date: 2002-10 Impact factor: 5.115
Authors: C Cognard; Y P Gobin; L Pierot; A L Bailly; E Houdart; A Casasco; J Chiras; J J Merland Journal: Radiology Date: 1995-03 Impact factor: 11.105