doi: 10.1161/01.STR.0000014772.02908.44
(Stroke. 2002;33:1233.)
© 2002 American Heart Association, Inc.
Original Contributions |
Clinical Course of Cranial Dural Arteriovenous Fistulas With Long-Term Persistent Cortical Venous Reflux
From the Division of Neurosurgery and Division of Neuroradiology (K.G.T., R.A.W., M.C.W.), University of Toronto Brain Vascular Malformations Study Group, Toronto, Ontario, Canada; and Department of Neurosurgery (J.M.C. van D.), Leiden University Medical Centre, Leiden, The Netherlands.
Correspondence to J. Marc C. van Dijk, MD, Toronto Western Hospital, Division of Neurosurgery, West Pavillion, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada. E-mail vandijk.md{at}planet.nl
Background and Purpose— The natural history of aggressive (Borden 2 and 3) cranial dural arteriovenous fistulas (DAVFs) is not well described. Reported annual mortality and hemorrhage rates vary widely and range up to 20% per year. A consecutive single-center cohort of 236 cases that presented with a cranial DAVF between June 1984 and May 2001 was reviewed for the consequences of long-term persistent cortical venous reflux (CVR).
Methods— A group of 118 cranial DAVFs was selected for the presence of CVR. All patients were offered treatment aimed at the disconnection of the CVR. Patients who declined or had partial treatment with persistence of the CVR had long-term clinical and angiographic follow-up to study the disease course of this select group.
Results— Treatment was instituted in 101 of the 118 patients (85.6%). Three patients were lost to follow-up. The remaining 14 nontreated patients (11.9%) and the partially treated patients (n=6) were assessed clinically and angiographically over time. The mean follow-up in this select group was 4.3 years (86.9 patient-years). During follow-up, 7 patients suffered an intracranial hemorrhage (35%). The incidence of nonhemorrhagic neurological deficit was 30%. Nine patients (45%) died: 6 patients expired after a hemorrhage, and 3 patients died of progressive neurological deterioration. Two patients demonstrated a spontaneous closure of the DAVF (10%).
Conclusions— Persistence of the CVR in cranial DAVFs yields an annual mortality rate of 10.4%. Excluding events at presentation, in this series the annual risk for hemorrhage or nonhemorrhagic neurological deficit during follow-up was 8.1% and 6.9%, respectively, resulting in an annual event rate of 15.0%.
Key Words: central nervous system vascular malformations • natural history • reflux, cortical venous • treatment outcome
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