Document Detail

Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas. Clinical article.
MedLine Citation:
PMID:  19425886     Owner:  NLM     Status:  MEDLINE    
OBJECT: Dural arteriovenous fistulas (DAVFs) with leptomeningeal venous reflux generally pose a high risk of aggressive manifestations including hemorrhage. Among DAVFs, there is a peculiar type that demonstrates direct drainage into the bridging vein rather than the dural venous sinus. The purpose of this study was to investigate the characteristics of DAVFs that drain directly into the petrosal vein or the bridging vein of the medulla oblongata. METHODS: Eleven consecutive cases of DAVFs that drained directly into the petrosal vein and 6 that drained directly into the bridging vein of the medulla were retrospectively reviewed. These cases were evaluated and/or treated at Hospital de Bicêtre in Paris, France, over a 27-year period. A review of previously reported cases was also performed. RESULTS: Both of these "extrasinusal"-type DAVFs demonstrated very similar characteristics. There was a significant male predominance (p < 0.001) for this lesion, and a significantly higher incidence of aggressive neurological manifestations including hemorrhage or venous hypertension than in DAVFs of the transverse-sigmoid or cavernous sinus (p < 0.001). This finding was considered to be attributable to leptomeningeal venous reflux. Regarding treatment, endovascular embolization (either transarterial or transvenous) is frequently difficult, and surgery may be an effective therapeutic choice in many instances. CONCLUSIONS: Embryologically, both the petrosal vein and the bridging vein of the medulla are cranial homologs of the spinal cord emissary bridging veins that drain the pial venous network. The authors believe that DAVFs in these locations may be included in a single category with spinal DAVFs because of their similar clinical characteristics.
Yutaka Mitsuhashi; Thaweesak Aurboonyawat; Vitor Mendes Pereira; Sasikhan Geibprasert; Frédérique Toulgoat; Augustin Ozanne; Pierre Lasjaunias
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  111     ISSN:  1933-0693     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-02     Completed Date:  2009-11-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  889-99     Citation Subset:  AIM; IM    
Service de Neuroradiologie Diagnostique et Therapeutique, Hospital de Bicêtre, Paris, France.
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MeSH Terms
Arteriovenous Fistula / complications,  surgery*
Cerebral Angiography
Cerebrovascular Circulation / physiology*
Dura Mater / blood supply
Headache / etiology
Magnetic Resonance Angiography
Medulla Oblongata / blood supply*,  surgery*
Middle Aged
Movement Disorders / etiology
Regional Blood Flow / physiology
Spinal Diseases / surgery*
Subarachnoid Hemorrhage / complications
Tomography, X-Ray Computed
Comment In:
J Neurosurg. 2009 Nov;111(5):887-8   [PMID:  19425898 ]

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