Na-Young Shin MD, Presenter: Nothing to Disclose

Dong Joon Kim MD, Abstract Co-Author: Nothing to Disclose

Byung Moon Kim MD, Abstract Co-Author: Nothing to Disclose

Sung Soo Ahn MD, Abstract Co-Author: Nothing to Disclose

Sung Jun Ahn MD, Abstract Co-Author: Nothing to Disclose

Intracranial dural arteriovenous shunt (DAVS) with cortical venous reflux (CVR) has a poor prognosis. However, the various venous angioarchitectural features in patients with CVR and its relationship with the natural history is not well known. The purpose of this study is to assess the relationship between the various venous angioarchitectural features on the long term clinical course of DAVSs.

Forty-one patients (M:F=24:17, mean age; 46.5 years, median follow up; 1.5 years) who were followed with untreated or post treatment persistent CVR were included. We evaluated the incidence of annual morbidity (hemorrhage or new/worsened nonhemorrhagic neurological deficit (NHND)) according to the venous angiographic patterns – isolated venous sinus, occlusion of draining sinus, venous ectasia, cortical collateral venous drainage, and pseudophlebitic pattern - on digital subtraction angiography.

The initial clinical presentation were benign (headaches, pulsatile tinnitus, or orbital phenomena) in 19 patients and aggressive (hemorrhage or NHND) in 22 patients. During 111.9 patient-years of follow up, the overall annual morbidity rate was 11.6% (mortality; n=3, rate; 2.6%/yr). Hemorrhage occurred in 5 patients (12.2%, rate; 4.5%/yr) and new/worsened NHND occurred in 8 patients (19.5%, rate; 7.2%/yr). Patients with isolated venous sinus showed a significantly higher annual incidence of hemorrhage or new/worsened NHND than in patients without isolated venous sinus (p=0.016, rate; 91.2%/yr vs 9.2%/yr, hazard ratio; x19.5). Initial aggressive symptomatic presentation showed a tendency toward aggressive clinical course without statistical significancy (p=0.052).

Venous angioarchtectural features may be predictive of the clinical course of DAVSs. The presence of isolated venous sinus is a risk factor for aggressive clinical course in patients with DAVS with persistent CVR.

Because presence of isolated venous sinus is a risk factor for aggressive clinical course in DAVS with persistent CVR, acute and aggressive treatment should be considered when it is noted on DSA.

Shin, N, Kim, D, Kim, B, Ahn, S, Ahn, S, Venous Angioarchitectural Features of Intracranial DAVS and Its Relation to the Long Term Clinical Course.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12031804.html