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Updated: Sep 25, 2026

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Venous congestive encephalopathy related to cranial dural arteriovenous fistulas
J Marc van Dijk1, Robert A Willinsky
1Department of Neurosurgery, Leiden University Medical Center JII-85, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Abstract:
Cranial DAVFs present with a wide spectrum of clinical findings from pulsatile tinnitus alone to intracranial hemorrhage and NHND. The neurologic sequelae are a consequence of venous hypertension and venous congestion. DAVFs with CVR can present with or develop a VCE that can be recognized on MR imaging as a diffuse T2 hyperintensity in the deep white matter of the cerebral or cerebellar hemispheres. The T2 hyperintensity has a characteristic peripheral enhancement. The telltale sign on MR imaging is the plethora of prominent pial vessels on the surface of the brain that are the engorged cortical veins participating in the cortical venous reflux. Selective angiography is critical for the accurate assessment of the CVR. DAVFs with CVR require prompt treatment, either endovascular alone or a combination of endovascular treatment and surgery.
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