Abstract
BackgroundDural arteriovenous fistulas are intracranial vascular malformations, fed by dural arteries and draining venous sinuses or meningeal veins. Clinical course varies widely and ranges from benign with spontaneous remission to fatal, due to cerebral hemorrhage. In a 10-year single institution experience, clinical presentation of dural arteriovenous fistulas, and in particular headache and angiographic features, as well as long-term outcome were analyzed.MethodsData of 42 intracranial dural arteriovenous fistulas of 40 patients concerning demographic characteristics, medical history and risk factors, clinical presentation and headache features, location and neuroimaging findings, as well as treatment and outcome, were collected. Furthermore, we used the modified-Rankin Scale to assess the long-term outcome, by telephone contact with patients and/or their relatives.ResultsPatients aged between 25 and 89 years (mean age 55.8 ± 15.5). According to different clinical presentation and evolution, related to their unique drainage pattern into the cavernous sinus, we examined the carotid-cavernous fistulas separately from other dural arteriovenous fistulas. Interestingly, we found that the migraine-like headache was the major onset symptom of dural arteriovenous fistulas different from carotid-cavernous fistulas (p = 0.036). On the other hand, non-migraine-like headache was a typical characteristic of carotid-cavernous fistulas (p = 0.003). Moreover, ocular symptoms were more frequently observed in carotid-cavernous fistulas (92.9% p < 0.001). Seventy percent of patients did not report any impact on quality of life (mRS 0 or 1) at follow-up.ConclusionsThese findings suggest a link between the site of lesion and clinical features of the headache, a symptom that usually leads to hospitalization. In particular, ocular symptoms accompanying non-migraine-like headache should be promptly recognized and raise the suspicion of a carotid-cavernous fistula, while migraine-like headache may suggests other dural arteriovenous fistulas. This study provides new significant insights on headache and its characteristics as a presentation symptom in dural arteriovenous fistulas.
Highlights
Dural arteriovenous fistulas are intracranial vascular malformations, fed by dural arteries and draining venous sinuses or meningeal veins
Looking for patients discharged from our Hospital in a 10-year period with the diagnosis of a “cerebral-vascular system abnormality”, we found 964 cases: 921 were excluded because they were vascular malformations of other subtypes than Dural arteriovenous fistulas (DAVFs) such as arterio-venous malformations, aneurisms, extra-cranial fistulas and venous teleangiectasias
According to the well-known different clinical presentation and evolution related to their unique drainage pattern into the cavernous sinus [16, 17] we examined carotid-cavernous fistulas (CCFs) separately from other DAVFs
Summary
Dural arteriovenous fistulas are intracranial vascular malformations, fed by dural arteries and draining venous sinuses or meningeal veins. Clinical course varies widely and ranges from benign with spontaneous remission to fatal, due to cerebral hemorrhage. In a 10-year single institution experience, clinical presentation of dural arteriovenous fistulas, and in particular headache and angiographic features, as well as long-term outcome were analyzed. Dural arteriovenous fistulas (DAVFs) are peculiar intracranial vascular malformations, fed by dural arteries and draining venous sinuses or meningeal veins. They constitute up to10–15% of cerebral vascular malformations [1]. The clinical course of DAVFs varies widely and ranges from benign with spontaneous remission to fatal due to cerebral hemorrhage [5]. High-grade DAVFs and retrograde leptomeningeal venous drainage seem to Corbelli et al The Journal of Headache and Pain (2020) 21:6 be related to a more aggressive neurological presentation [6,7,8,9]
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