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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Clinical and angiographic characteristics of multiple dural arteriovenous shunts
1Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
Insights
Multiple dural arteriovenous fistulas (DAVFs) are linked to poorer outcomes and aggressive symptoms. Sinus thrombosis plays a key role in their development, necessitating prompt management strategies for these complex vascular lesions.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Multiple dural arteriovenous fistulas (DAVFs) are uncommon, and their pathogenesis and clinical characteristics remain poorly understood.
- Understanding the factors contributing to multiple DAVFs is crucial for effective patient management.
Purpose of the Study:
- To investigate the angiographic and clinical features of patients with multiple DAVFs.
- To elucidate the underlying pathomechanisms, particularly the role of dural sinus thrombosis.
Main Methods:
- Retrospective review of 179 patients diagnosed with DAVS.
- Inclusion criteria: patients with two or more DAVFs at separate anatomical sites.
- Categorization into synchronous and metachronous types, followed by analysis of angiographic and clinical data.
Main Results:
- Fourteen patients (7.8%) presented with multiple DAVFs (7 synchronous, 7 metachronous).
- Most cases (93%) exhibited cortical venous reflux (Borden type II/III).
- Dural sinus thrombosis was a frequent comorbidity (71.4%), associated with both synchronous and metachronous DAVF development.
Conclusions:
- Multiple DAVFs are associated with aggressive clinical presentation and poor prognosis, demanding aggressive treatment.
- Dural sinus thrombosis is a significant factor in the pathomechanism of multiple DAVFs.
Background And Purpose:
The pathogenesis and characteristics of multiple DAVSs are not well-known. The purpose of this study was to evaluate the angiographic and clinical characteristics of patients with multiple DAVSs with an emphasis on the pathomechanism.
Materials And Methods:
One hundred seventy-nine patients with DAVS were reviewed. Patients with ≥ 2 fistulas at anatomically separate sites were included. Multiple DAVSs were categorized into synchronous (simultaneous multiplicity) or metachronous (temporal sequential development of multiplicity) types. The angiographic and clinical characteristics of these lesions were analyzed.
Results:
Fourteen patients were diagnosed with multiple DAVSs (7.8%; synchronous, n = 7; metachronous, n = 7). Thirteen of the 14 patients showed CVR (93%, Borden type II/III). Multiple DAVSs were frequently associated with dural sinus thrombosis (71.4%, n = 10). Synchronous DAVSs developed in association with an occluded sinus (n = 5). De novo metachronous lesions developed in association with thrombosis of a previously patent dural sinus (n = 3) or reopening of an occluded sinus (n = 2). Multiplicity was associated with aggressive initial symptoms in 64.3% (n = 9). The newly developed lesions in the metachronous types were accompanied by hemorrhage (n = 1), neurologic deficit (n = 1), worsening of the initial benign symptoms (n = 2), and incidental detection (n = 3). The mean time interval between the initial diagnosis and de novo lesion detection was 31.3 ± 29.8 months (range, 12-92 months).
Conclusions:
Multiplicity of DAVSs is associated with poor angiographic and clinical prognosis, requiring an aggressive treatment and management strategy. Sinus thrombosis has a prominent role in the pathomechanism of DAVSs.
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