Abstract
PurposeTo investigate which clinical and angioarchitectural features were associated with the occurrence of intracranial hemorrhage in patients with intracranial dural arteriovenous fistulas (DAVFs).Materials and MethodsWe retrospectively reviewed the clinical and angioarchitectural features of 236 consecutive patients diagnosed with DAVF in our department from April 2009 to November 2013. Two groups of patients, with or without intracranial hemorrhage as clinical presentation at the initial diagnosis, were analysed to identify the differences in clinical and angioarchitectural features in univariate analysis. A multivariate logistic regression model was also developed to assess the independent contribution of the potential risk factors. Associations were considered significant for p<0.05.ResultsFifty-six patients (23.7%) presented with intracranial hemorrhage at the initial diagnosis of DAVF. In univariate analysis, male patients (p = 0.002), patients with medical history of smoking (p<0.001) or alcohol consumption (p = 0.022), and DAVFs located at the tentorium (p = 0.010), frontalbasal (p = 0.007), foramen magnum (p = 0.043) or cerebral convexity (p<0.001) were associated with an increased risk of intracranial hemorrhage. A higher risk of hemorrhagic occurrence was also observed in DAVFs with superficial cortical venous drainage (p<0.001), deep venous drainage (p = 0.003), occluded venous sinus (p<0.032), or higher Borden type (p<0.001). A multivariate logistic regression model showed that intracranial hemorrhage in patients with DAVFs was correlated with higher Borden classification (OR 5.880; 95% CI, 3.370–10.257; p<0.001).ConclusionVenous drainage pattern was the only independent risk factor of intracranial hemorrhage in our patients with intracranial DAVF. The other potential risk factors may be confounding factors in predicting intracranial hemorrhage.
Highlights
Intracranial dural arteriovenous fistulas (DAVFs) are special arteriovenous malformations (AVMs) inside the dura that manifest with a variety of clinical presentations, including pulsatile tinnitus, headache, exophthalmos, and sometimes nonhemorrhagic neurologic deficits or intracranial hemorrhage [1, 2]
Male patients (p = 0.002), patients with medical history of smoking (p
A higher risk of hemorrhagic occurrence was observed in DAVFs with superficial cortical venous drainage (p
Summary
Intracranial dural arteriovenous fistulas (DAVFs) are special arteriovenous malformations (AVMs) inside the dura that manifest with a variety of clinical presentations, including pulsatile tinnitus, headache, exophthalmos, and sometimes nonhemorrhagic neurologic deficits or intracranial hemorrhage [1, 2]. Several previous retrospective studies have analyzed the risk factors of intracranial DAVF associated with hemorrhage [2, 4, 5, 7,8,9,10,11,12]. Most of these studies focused only on angioarchitectural characteristics [2, 5, 7,8,9,10,11,12] and some of these studies included only < 100 patients [7,8,9, 11]. Based on a large series of patients with DAVF, the purpose of this study was to identify the clinical and angioarchitectural features that were associated with the occurrence of intracranial hemorrhage
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