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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1998 Sep;65(3):308–316. doi: 10.1136/jnnp.65.3.308

Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow

C Cognard 1, A Casasco 1, M Toevi 1, E Houdart 1, J Chiras 1, J Merland 1
PMCID: PMC2170225  PMID: 9728941

Abstract

OBJECTIVES—A retrospective study was carried out on 13 patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with isolated or associated signs of intracranial hypertension.
METHODS—Nine patients presented with symptoms of intracranial hypertension at the time of diagnosis. Ocular fundoscopy available in 12 patients showed bilateral papilloedema in eight and optic disk atrophy in four. Clinical evolution was particularly noticeable in five patients because of chronic (two patients) or acute (after lumbar shunting or puncture: three patients, one death) tonsillar herniation.
RESULTS—Two patients had a type I fistula (drainage into a sinus, with a normal antegrade flow direction). The remaining 11 had type II fistulas (drainage into a sinus, with abnormal retrograde venous drainage into sinuses or cortical veins). Stenosis or thrombosis of the sinus(es) distal to the fistula was present in five patients. The cerebral venous drainage was abnormal in all patients.
CONCLUSION—Type II (and some type I) DAVFs may present as isolated intracranial hypertension mimicking benign intracranial hypertension. Normal cerebral angiography should be added as a fifth criterion of benign intracranial hypertension. The cerebral venous drainage pattern must be carefully studied by contralateral carotid and vertebral artery injections to correctly evaluate the impairment of the cerebral venous outflow. Lumbar CSF diversion (puncture or shunting) may induce acute tonsillar herniation and should be avoided absolutely. DAVF may induce intracranial hypertension, which has a poor long term prognosis and may lead to an important loss of visual acuity and chronic tonsillar herniation. Consequently, patients with intracranial hypertension must be treated, even agressively, to obliterate the fistula or at least to reduce the arterial flow and to restore a normal cerebral venous drainage. The endovascular treatment may associate arterial or transvenous embolisation and /or surgery. Patients in whom the fistula is not obliterated after an endovascular therapeutic procedure, need continous clinical and angiographical follow up.



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Selected References

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  1. Ameri A., Bousser M. G. Cerebral venous thrombosis. Neurol Clin. 1992 Feb;10(1):87–111. [PubMed] [Google Scholar]
  2. Barnwell S. L., Halbach V. V., Dowd C. F., Higashida R. T., Hieshima G. B. Dural arteriovenous fistulas involving the inferior petrosal sinus: angiographic findings in six patients. AJNR Am J Neuroradiol. 1990 May;11(3):511–516. [PMC free article] [PubMed] [Google Scholar]
  3. Barnwell S. L., Halbach V. V., Dowd C. F., Higashida R. T., Hieshima G. B., Wilson C. B. A variant of arteriovenous fistulas within the wall of dural sinuses. Results of combined surgical and endovascular therapy. J Neurosurg. 1991 Feb;74(2):199–204. doi: 10.3171/jns.1991.74.2.0199. [DOI] [PubMed] [Google Scholar]
  4. Chaudhary M. Y., Sachdev V. P., Cho S. H., Weitzner I., Jr, Puljic S., Huang Y. P. Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. AJNR Am J Neuroradiol. 1982 Jan-Feb;3(1):13–19. [PMC free article] [PubMed] [Google Scholar]
  5. Cognard C., Gobin Y. P., Pierot L., Bailly A. L., Houdart E., Casasco A., Chiras J., Merland J. J. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995 Mar;194(3):671–680. doi: 10.1148/radiology.194.3.7862961. [DOI] [PubMed] [Google Scholar]
  6. Cognard C., Houdart E., Casasco A., Gabrillargues J., Chiras J., Merland J. J. Long-term changes in intracranial dural arteriovenous fistulae leading to worsening in the type of venous drainage. Neuroradiology. 1997 Jan;39(1):59–66. doi: 10.1007/s002340050368. [DOI] [PubMed] [Google Scholar]
  7. Convers P., Michel D., Brunon J., Sindou M. Fistules artérioveineuses durales de la fosse cérébrale postérieure et thrombose du sinus latéral. Discussion de leurs relations et de leur traitement à propos de deux cas. Neurochirurgie. 1986;32(6):495–500. [PubMed] [Google Scholar]
  8. Danzé F., Rosa A., Mizon J. P. Hypertension intracrânienne bénigne (pseudo tumor cerebri). Douze cas. Rev Neurol (Paris) 1984;140(1):37–44. [PubMed] [Google Scholar]
  9. Donaldson J. O. Pathogenesis of pseudotumor cerebri syndromes. Neurology. 1981 Jul;31(7):877–880. doi: 10.1212/wnl.31.7.877. [DOI] [PubMed] [Google Scholar]
  10. Durcan F. J., Corbett J. J., Wall M. The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana. Arch Neurol. 1988 Aug;45(8):875–877. doi: 10.1001/archneur.1988.00520320065016. [DOI] [PubMed] [Google Scholar]
  11. FOLEY J. Benign forms of intracranial hypertension; toxic and otitic hydrocephalus. Brain. 1955;78(1):1–41. doi: 10.1093/brain/78.1.1. [DOI] [PubMed] [Google Scholar]
  12. Fermand M., Reizine D., Melki J. P., Riche M. C., Merland J. J. Long term follow-up of 43 pure dural arteriovenous fistulae (AVF) of the lateral sinus. Neuroradiology. 1987;29(4):348–353. doi: 10.1007/BF00348913. [DOI] [PubMed] [Google Scholar]
  13. Gelwan M. J., Choi I. S., Berenstein A., Pile-Spellman J. M., Kupersmith M. J. Dural arteriovenous malformations and papilledema. Neurosurgery. 1988 Jun;22(6 Pt 1):1079–1084. doi: 10.1227/00006123-198806010-00020. [DOI] [PubMed] [Google Scholar]
  14. Gobin Y. P., Houdart E., Rogopoulos A., Casasco A., Bailly A. L., Merland J. J. Percutaneous transvenous embolization through the thrombosed sinus in transverse sinus dural fistula. AJNR Am J Neuroradiol. 1993 Sep-Oct;14(5):1102–1105. [PMC free article] [PubMed] [Google Scholar]
  15. Guidetti B., Giuffrè R., Gambacorta D. Follow-up study of 100 cases of pseudotumor cerebri. Acta Neurochir (Wien) 1968;18(4):259–267. doi: 10.1007/BF01405720. [DOI] [PubMed] [Google Scholar]
  16. Halbach V. V., Higashida R. T., Hieshima G. B., Goto K., Norman D., Newton T. H. Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients. Radiology. 1987 May;163(2):443–447. doi: 10.1148/radiology.163.2.3562824. [DOI] [PubMed] [Google Scholar]
  17. Halbach V. V., Higashida R. T., Hieshima G. B., Mehringer C. M., Hardin C. W. Transvenous embolization of dural fistulas involving the transverse and sigmoid sinuses. AJNR Am J Neuroradiol. 1989 Mar-Apr;10(2):385–392. [PMC free article] [PubMed] [Google Scholar]
  18. Handa J., Yoneda S., Handa H. Venous sinus occlusion with a dural arteriovenous malformation of the posterior fossa. Surg Neurol. 1975 Nov;4(5):433–437. [PubMed] [Google Scholar]
  19. Houser O. W., Baker H. L., Jr, Rhoton A. L., Jr, Okazaki H. Intracranial dural arteriovenous malformations. Radiology. 1972 Oct;105(1):55–64. doi: 10.1148/105.1.55. [DOI] [PubMed] [Google Scholar]
  20. Janny P., Chazal J., Colnet G., Devoize J. L., Barretto L. C. L'hypertension intracrânienne bénigne. Etude clinique, physiopathologique et nosographique. Neurochirurgie. 1981;27(2):79–88. [PubMed] [Google Scholar]
  21. Johnston I., Hawke S., Halmagyi M., Teo C. The pseudotumor syndrome. Disorders of cerebrospinal fluid circulation causing intracranial hypertension without ventriculomegaly. Arch Neurol. 1991 Jul;48(7):740–747. doi: 10.1001/archneur.1991.00530190088020. [DOI] [PubMed] [Google Scholar]
  22. Johnston I., Paterson A. Benign intracranial hypertension. I. Diagnosis and prognosis. Brain. 1974 Jun;97(2):289–300. doi: 10.1093/brain/97.1.289. [DOI] [PubMed] [Google Scholar]
  23. Johnston I., Paterson A. Benign intracranial hypertension. II. CSF pressure and circulation. Brain. 1974 Jun;97(2):301–312. doi: 10.1093/brain/97.1.301. [DOI] [PubMed] [Google Scholar]
  24. Kosnik E. J., Hunt W. E., Miller C. A. Dural arteriovenous malformations. J Neurosurg. 1974 Mar;40(3):322–329. doi: 10.3171/jns.1974.40.3.0322. [DOI] [PubMed] [Google Scholar]
  25. Kühner A., Krastel A., Stoll W. Arteriovenous malformations of the transverse dural sinus. J Neurosurg. 1976 Jul;45(1):12–19. doi: 10.3171/jns.1976.45.1.0012. [DOI] [PubMed] [Google Scholar]
  26. Lalwani A. K., Dowd C. F., Halbach V. V. Grading venous restrictive disease in patients with dural arteriovenous fistulas of the transverse/sigmoid sinus. J Neurosurg. 1993 Jul;79(1):11–15. doi: 10.3171/jns.1993.79.1.0011. [DOI] [PubMed] [Google Scholar]
  27. Lamas E., Lobato R. D., Esperarza J., Escudero L. Dural posterior fossa AVM producing raised sagittal simus pressure. Case report. J Neurosurg. 1977 Jun;46(6):804–810. doi: 10.3171/jns.1977.46.6.0804. [DOI] [PubMed] [Google Scholar]
  28. Lasjaunias P., Chiu M., ter Brugge K., Tolia A., Hurth M., Bernstein M. Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg. 1986 May;64(5):724–730. doi: 10.3171/jns.1986.64.5.0724. [DOI] [PubMed] [Google Scholar]
  29. Lasjaunias P., Halimi P., Lopez-Ibor L., Sichez J. P., Hurth M., De Tribolet N. Traitement endovasculaire des malformations vasculaires durales (MVD) pures "spontanées". Revue de 23 cas explorés et traités entre mai 1980 et octobre 1983. Neurochirurgie. 1984;30(4):207–223. [PubMed] [Google Scholar]
  30. Mas J. L., Meder J. F., Meary E., Bousser M. G. Magnetic resonance imaging in lateral sinus hypoplasia and thrombosis. Stroke. 1990 Sep;21(9):1350–1356. doi: 10.1161/01.str.21.9.1350. [DOI] [PubMed] [Google Scholar]
  31. Nishijima M., Takaku A., Endo S., Kuwayama N., Koizumi F., Sato H., Owada K. Etiological evaluation of dural arteriovenous malformations of the lateral and sigmoid sinuses based on histopathological examinations. J Neurosurg. 1992 Apr;76(4):600–606. doi: 10.3171/jns.1992.76.4.0600. [DOI] [PubMed] [Google Scholar]
  32. Obrador S., Soto M., Silvela J. Clinical syndromes of arteriovenous malformations of the transverse-sigmoid sinus. J Neurol Neurosurg Psychiatry. 1975 May;38(5):436–451. doi: 10.1136/jnnp.38.5.436. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Piton J., Guilleux M. H., Guibert-Tranier F., Caille J. M. Fistulae of the lateral sinus. J Neuroradiol. 1984;11(3):143–159. [PubMed] [Google Scholar]
  34. Roland J., Bernard C., Bracard S., Czorny A., Floquet J., Race J. M., Forlodou P., Picard L. Microvascularization of the intracranial dura mater. Surg Radiol Anat. 1987;9(1):43–49. doi: 10.1007/BF02116853. [DOI] [PubMed] [Google Scholar]
  35. Round R., Keane J. R. The minor symptoms of increased intracranial pressure: 101 patients with benign intracranial hypertension. Neurology. 1988 Sep;38(9):1461–1464. doi: 10.1212/wnl.38.9.1461. [DOI] [PubMed] [Google Scholar]
  36. Rousseaux P., Vieillart A., Scherpereel B., Bernard M. H., Motte J., Guyot J. F. Hypertension intracrânienne bénigne (17 cas) et thromboses veineuses cérébrales (49 cas). Etude comparative. Neurochirurgie. 1985;31(5):381–389. [PubMed] [Google Scholar]
  37. Rush J. A. Pseudotumor cerebri: clinical profile and visual outcome in 63 patients. Mayo Clin Proc. 1980 Sep;55(9):541–546. [PubMed] [Google Scholar]
  38. Silberstein S. D., Marcelis J. Headache associated with changes in intracranial pressure. Headache. 1992 Feb;32(2):84–94. doi: 10.1111/j.1526-4610.1992.hed3202084.x. [DOI] [PubMed] [Google Scholar]
  39. Urtasun F., Biondi A., Casaco A., Houdart E., Caputo N., Aymard A., Merland J. J. Cerebral dural arteriovenous fistulas: percutaneous transvenous embolization. Radiology. 1996 Apr;199(1):209–217. doi: 10.1148/radiology.199.1.8633147. [DOI] [PubMed] [Google Scholar]
  40. Viñuela F., Fox A. J., Pelz D. M., Drake C. G. Unusual clinical manifestations of dural arteriovenous malformations. J Neurosurg. 1986 Apr;64(4):554–558. doi: 10.3171/jns.1986.64.4.0554. [DOI] [PubMed] [Google Scholar]
  41. Wall M., George D. Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain. 1991 Feb;114(Pt 1A):155–180. [PubMed] [Google Scholar]
  42. Watanabe A., Takahara Y., Ibuchi Y., Mizukami K. Two cases of dural arteriovenous malformation occurring after intracranial surgery. Neuroradiology. 1984;26(5):375–380. doi: 10.1007/BF00327490. [DOI] [PubMed] [Google Scholar]

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