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Clinical and Angioarchitectural Features of Ruptured Dural Arteriovenous Fistulas

Ayman M Qureshi1, Kartik Bhatia1, Alex Kostynskyy1

  • 1Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.

World Neurosurgery
|December 31, 2020
PubMed

Insights

Hemorrhage from cranial dural arteriovenous fistulas (DAVFs) is often intraparenchymal, with venous aneurysms frequently causing the bleed. Early embolization offers high cure rates for ruptured DAVFs, leading to favorable outcomes.

Area of Science:

  • Neurosurgery
  • Neuroradiology
  • Vascular Neurology

Background:

  • Hemorrhage is a significant complication of cranial dural arteriovenous fistulas (DAVFs).
  • Existing grading systems (Cognard, Borden) assess hemorrhage risk.
  • This study aimed to define the angioarchitecture of ruptured DAVFs.

Purpose of the Study:

  • To identify specific angioarchitectural features associated with ruptured cranial DAVFs.
  • To correlate fistula anatomy with hemorrhage location and outcomes.
  • To evaluate treatment strategies and clinical outcomes for ruptured DAVFs.

Main Methods:

  • Retrospective analysis of 41 ruptured cranial DAVF cases (2004-2019).
  • Review of medical records and imaging for hematoma location, fistula anatomy, classification, venous pouches, collecting veins, stenosis, treatment, and outcomes.
  • Analysis of angioarchitectural characteristics of ruptured lesions.

Main Results:

  • Mean patient age was 60 years, with 61% males.
  • Intraparenchymal hemorrhage was most common; transverse-sigmoid, tentorial, and convexity fistulae predominated.
  • Multi-feeder-common-hole configuration (71%) and venous aneurysms (64%) were frequent; aneurysms communicated with hematoma in 88% of cases.
  • Endovascular treatment was used in 72%, with 64% treated within 7 days.
  • Five patients re-bled; 83% achieved functional independence.

Conclusions:

  • Intraparenchymal hemorrhage is the typical presentation of ruptured cranial DAVFs.
  • Venous aneurysms are common and often the source of bleeding.
  • Early endovascular embolization is recommended due to high cure rates and re-hemorrhage risk.
  • Despite hemorrhage, cranial DAVFs generally have favorable clinical outcomes.
Abstract

Keywords:
AngioarchitectureDural arteriovenous fistula (DAVF)Hemorrhage

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