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(Stroke. 2008;39:1735.)
© 2008 American Heart Association, Inc.

Original Contributions

Natural History of Dural Arteriovenous Shunts

Michael Söderman, MD, PhD; Ladislav Pavic, MD, PhD; Göran Edner, MD; Staffan Holmin, MD, PhD Tommy Andersson, MD, PhD

From the Departments of Neuroradiology (M.S., S.H., T.A.) and Neurosurgery (G.E.), Karolinska University Hospital, Stockholm, Sweden; and the Department of Radiology (L.P.), University Hospital Dubrava, Zagreb, Croatia.

Correspondence to Michael Söderman, MD, PhD, Department of Neuroradiology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden. E-mail michael.soderman{at}karolinska.se

Background and Purpose— Dural arteriovenous shunts with cortical venous reflux or drainage may cause neurological symptoms and death with or without intracranial hemorrhage. Present knowledge about the natural history of these lesions is limited, however. We investigated the incidences of intracranial hemorrhage, progressive dementia syndrome, and death in patients diagnosed in our neurovascular center.

Methods— We evaluated the records of 85 patients with dural arteriovenous shunts with cortical venous drainage or reflux hospitalized in our institution from 1978 to 2007. The annual incidences of intracranial hemorrhage, progressive dementia syndrome, and death were calculated.

Results— Fifty-three patients did not have an intracranial hemorrhage as the presenting event. One of these patients bled after diagnosis. Thirty-two patients had an intracranial hemorrhage as the presenting event. Three patients bled after diagnosis. One of these patients died. Apart from deficits caused by hemorrhage, no patient reported adverse neurological symptoms. In patients presenting with an intracranial hemorrhage the annual risk for hemorrhage is approximately 7.4% and in those not presenting with a hemorrhage it is approximately 1.5%.

Conclusion— The risk of intracranial hemorrhage from a dural arteriovenous shunt with cortical venous drainage is most likely smaller than previously proposed. Presentation with hemorrhage is a risk factor for hemorrhage. The risks of developing neurological symptoms not related to hemorrhage are also less than previously reported.

Key Words: dural arteriovenous fistula • dural arteriovenous shunts • hemorrhage • natural course • natural history

This article has been cited by other articles:

				J. M. C. van Dijk, K. G. TerBrugge, R. A. Willinsky, and M. C. Wallace The Natural History of Dural Arteriovenous Shunts: The Toronto Experience Stroke, May 1, 2009; 40(5): e412 - e412. [Full Text] [PDF]

				M. Soderman, L. Pavic, G. Edner, S. Holmin, and T. Andersson Response to Letter by van Dijk et al Stroke, May 1, 2009; 40(5): e413 - e414. [Full Text] [PDF]