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(Stroke. 2005;36:976.)
© 2005 American Heart Association, Inc.

Original Contributions

Assessment of Dural Arteriovenous Fistulae by Transcranial Color-Coded Duplex Sonography

From the Department of Neurology (J.U.H., C.K.), Aachen University Hospital, Germany; Departments of Neurology (O.P.) and Radiology and Neuroradiology (H.H.H.), Alfried Krupp Hospital, Essen, Germany; and Kliniken Schmieder Allensbach/Hegau Klinikum (C.K.), Singen, Germany.

Correspondence to Dr Judith U. Harrer, Department of Neurology, Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany. E-mail Judith.Harrer{at}web.de

Background and Purpose— To study hemodynamic changes and to determine the value of contrast-enhanced transcranial color-coded sonography (TCCS) for the evaluation of dural arteriovenous fistulae (DAVF) before and after transcatheter embolization.

Methods— Twenty-four patients (mean age 61±11 years) with occipitally located DAVF were studied with contrast-enhanced TCCS using the transtemporal bone window in transverse-axial and coronal insonation planes. Blood flow velocity measurements of all depictable basal cerebral veins and sinuses were obtained before and after transcatheter embolization. Pretreatment and post-treatment flow velocity values were compared. Results of digital subtraction angiography (DSA) were compared with sonographic findings.

Results— Four of the 24 patients (17%) could not be studied because of an insufficient temporal bone window. In all remaining patients (n=20), draining veins/sinuses could be identified because of pathologically increased blood flow velocities with peak systolic flow velocities of >50 cm/s. Of the 27 draining vessels depicted by DSA, TCCS correctly identified 25 (93%): the basal vein (3 of 3), the straight sinus (3 of 3), the superior sagittal sinus (1 of 3), the transverse sinus (9), the sigmoid sinus (4), and the superior petrosal sinus (5/5). However, TCCS failed to depict supplementary drainage via cortical veins. After transcatheter embolization, mean reduction of blood flow velocity was 44±18% (P<0.01) compared with pretreatment values.

Conclusions— Contrast-enhanced TCCS is a promising technique for monitoring embolization of DAVF, follow-up after complete fistula occlusion, and may even be useful as a screening tool in patients with pulsatile tinnitus.

Key Words: arteriovenous fistula • central nervous system vascular malformations • contrast media • embolization, therapeutic • ultrasonography, Doppler, transcranial