Sinus Dural Arteriovenous Fistula Research Articles

Proposal of a Classification System of Cavernous Sinus Dural Arteriovenous Fistulas and Treatment Strategies Based on Angioarchitecture: A Cohort Study of 116 Patients

Cavernous sinus(CS) dural arteriovenous fistulas(DAVFs) are commonly treated by transvenous embolization, but the details of treatment need to be more clearly defined. We propose a classification of CS-DAVF that can contribute to formulating endovascular treatment process. CS-DAVF was classified into seven categories based on the cumulative CS range and drainage patterns. CS-DAVF angioarchitecture, clinical characteristics, treatment strategies, and outcomes of CS-DAVF patients treated in our hospital from 2012 to 2021 were summarized and analyzed. Among the 116 patients with CS-DAVF: Type 1, 71(61.2%); Type 2, 9(7.8%); Type 3, 18(15.5%); Type 4, 2(1.7%); Type 5, 8(6.9%); Type 6, 3(2.6%); and Type 7, 5(4.3%). Intercavernous sinus or inferior petrosal sinus drainage was relatively rare in Types 1 and 6(p<0.001 and p<0.001); basilar venous plexus drainage was more prevalent in Types 2, 5, and 7(p=0.019). Inferior petrosal sinus occlusion was more commonly seen in Types 2, 3, and 5(p=0.005). The most frequent first symptoms and symptoms at admission in patients with CS-DAVF is ocular/orbital symptoms, occurring in 64 cases (55.2%) and 104 cases (89.7%), respectively. In this study, 108 patients (93.1%) underwent endovascular embolization. Among those who received endovascular embolization, 96(88.9%) CS-DAVFs were treated via transvenous embolization. In long-term follow-up, 98 cases (84.5%) achieved cure, and 17 cases (14.7%) showed symptomatic improvement. Our proposed classification system based on cumulative CS range and drainage patterns can assist in formulating treatment strategies for transvenous embolization.

Venous Sinus Thrombosis and Dural Arteriovenous Fistula after Herpes Simplex Encephalitis in a Patient with Protein S, Protein C Deficiency

Herpes simplex encephalitis is known to cause intracranial hypertension and cerebral edema. When cerebral edema occurs, venous sinuses are compressed, resulting in congestion and thrombosis. An arteriovenous fistula may form as a result, particularly in conjunction with superior sagittal sinus thrombosis. In this report, the authors describe a patient with protein S and C deficiency who developed venous sinus thrombosis and dural arteriovenous fistula after experiencing herpes simplex encephalitis.

Angioarchitecture and Associated Dural Arteriovenous Fistulas of the Superior Petrosal Sinus and Petrosal Vein

The superior petrosal sinus and petrosal vein are important drainage routes for the posterior cranial fossa, with some variations and collateral vessels. An anterolateral-type tentorial dural arteriovenous fistula, which occurs around the petrosal vein, often develops aggressive symptoms due to venous reflux to the brainstem and cerebellum. Neuroendovascular treatment of this fistula is usually challenging because transarterial embolization has a high risk and indications for transvenous embolization are limited. In the cavernous sinus and transverse sinus/sigmoid sinus dural arteriovenous fistulas, venous reflux to the petrosal vein is dangerous, and a treatment strategy with the occlusion of the petrosal vein is indispensable. Furthermore, attention should be paid to venous approaches through the superior petrosal sinus.

Stereotactic radiosurgery for noncavernous sinus dural arteriovenous fistulas: treatment outcomes and their predictors.

Stereotactic radiosurgery (SRS) has emerged as a safe and effective treatment modality for dural arteriovenous fistulas (dAVFs), particularly cavernous sinus (CS) dAVFs. However, the long-term outcomes of non-CS dAVFs are not well known. This study aimed to evaluate the efficacy and safety of SRS for non-CS dAVFs and to investigate the risk factors for incomplete obliteration. Between 2007 and 2020, 65 non-CS dAVFs in 63 patients were treated using SRS at a single institution. Demographic characteristics, initial clinical presentations, clinical outcomes, and radiological findings were retrospectively reviewed. The procedure-related complications were assessed. Radiological outcomes were evaluated as complete obliteration, incomplete obliteration, and angiographic worsening, whereas clinical outcomes were evaluated for symptom recovery. At a median follow-up of 17 months, the overall complete obliteration rate was 63.1%, and the cumulative obliteration rates were 24.6%, 60.0%, 70.0%, and 74.3% at 12, 24, 36, and 48 months, respectively. Six patients underwent retreatment due to angiographic worsening; in 5 of these patients, recruitment of arterial feeders was newly observed in the adjacent sinus, which was not treated in the initial SRS. In the multivariate analysis, high-flow shunt and venous ectasia were associated with incomplete obliteration. No adverse events occurred after SRS. SRS for non-CS dAVFs is safe, and its efficacy is highly variable according to location. High-flow shunts may indicate greater radioresistance. In the retreated cases, new fistulas tended to be accompanied by sinus steno-occlusion and formed in the adjacent sinus segments.

Interventional Embolization of Unilateral Cavernous Sinus With ONXY Glue Combined With Coils for the Treatment of Bilateral Dural Arteriovenous Fistula.

To summarize the clinical experience of unilateral sponge sinus embolization of cavernous sinus dural arteriovenous fistula (CS DAVF) via jugular vein access with ONXY gel and spring coil intervention. The authors retrospectively analyzed the clinical data of 3 patients who were treated with unilateral cavernous sinus embolization for bilateral cavernous sinus dural arteriovenous fistula (CS DAVF) from October 2020 to May 2022 in our department by using transjugular vein access spring coil + ONXY gel interventional embolization. Immediate postoperative angiography suggested that the cavernous sinus fistula was completely embolized in all 3 patients, and cerebral angiography was carried out from 6 to 12 months after the operation and assessed using the Class grading method, and there was no recurrence in any of the 3 patients. Transvenous access ONXY adhesive combined with spring coil interventional embolization of unilateral cavernous sinus to cure bilateral cavernous sinus dural arteriovenous fistula is feasible, which can avoid the excessive use of spring coils and ONXY adhesive, and it is the key to the effective cure of DAVF in cavernous sinus area and to reduce the complication.

Dural arteriovenous fistulas involving the superior sagittal and parasagittal sinuses: clinical presentation, imaging characteristics and treatment strategies.

Dural arteriovenous fistulas (DAVFs) involving the superior sagittal (SSS) and parasagittal sinuses are often inappropriately classified. We explore the clinical presentations, imaging characteristics and endovascular treatment strategies these two DAVF subtypes. Clinical and imaging data of 19 patients with SSS or parasagittal sinus DAVFs who underwent endovascular treatment in our institution from 2017 and 2022 were retrospectively analyzed. The angiographic findings, endovascular treatment strategies and angiographic outcomes were evaluated and recorded. Among these 19 patients, 14 had a parasagittal DAVF, 4 had a SSS DAVF, one patient had both a parasagittal and SSS DAVF. Only one (1/19, 5.26%) patient presented with intracranial haemorrhage (ICH); For the parasagittal DAVF group, most of the shunts were located along the middle third of the SSS (12/15, 80%), on the dura in proximity with the junctional zone between the bridging vein and SSS (15/15, 100%), with ipsilateral cortical venous reflux (CVR) (15/15, 100%). For the SSS DAVF group, all 5 patients had shunting zone along the middle third of the SSS, on the sinus or parasinus wall, with bilateral CVR. Trans-arterial embolization, via the middle meningeal artery (MMA) as the primary route of access, was the primary treatment approach in 95% of cases (19/20). Reflux of embolization material into the SSS was observed in one case (1/5, 20%) of SSS DAVF in which balloon sinus protection was not used during embolization. Our study found that parasagittal DAVFs have shunting point(s) centred on the junctional zone of the bridging vein and the SSS with ipsilateral CVR, while SSS DAVFs have shunting point(s) centred on the sinus or parasinus wall with bilateral CVR. Trans-arterial embolization via the MMA(s) can be used as the primary treatment strategy in most cases. Balloon sinus protection during embolization is not necessary in cases of parasagittal DAVF with occluded or stenosed connection with the SSS but its use should be considered in cases of SSS DAVF with patent sinus. DAVF, Dural arteriovenous fistula; SSS, Superior sagittal sinus; CVR, Cortical venous reflux; MMA, middle meningeal artery; ICH, Intracranial haemorrhage; STA, Superficial temporal artery; OA, Occipital artery. CFD, Computational fluid dynamics.

De novo formation of remote dural arteriovenous fistula following treated cavernous sinus dural arteriovenous fistula

BackgroundThe development of new dural arteriovenous fistulas (DAVFs) at another location following endovascular treatment of cavernous sinus DAVFs (CSDAVFs) are extremely rare. Our aim is to review cases of de Novo DAVFs that occurred after treatment of CSDAVFs at our institution and those reported in the literature. MethodsWe reviewed all cases of CSDAVFs evaluated by 2 experienced neuroradiologists. A literature search was performed using the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines focusing on De Novo DAVFs following the endovascular treatment of cerebrovascular malformations. Addition articles were searched through the reference lists of the included articles. ResultsFrom June 2004 and September 2019., we identified 3 (2.5%) cases of De Novo DAVFs occurred after endovascular treatment or spontaneous obliteration of CSDAVFs from 119 treated CSDAVFs at our institute. Our review yielded 9 articles involving 12 patients with 15 de novo DAVFs, including our 3 patients. The mean age was 55.08 ± 12.9 years (range 43–69), 83.3% were females (n = 10). The new remote DAVFs occurred after endovascular treatment of CSDAVFs in 10 (83.3%) patients. The de novo DAVFs occurred following spontaneous complete regression in 2 (16.7%) patients. All de novo DAVFs developed after complete obliteration of treated CSDAVFs. ConclusionSinus thrombosis and elevated venous pressure may play an important role in the pathogenesis of a de novo DAVF formation. In addition, thrombophilic abnormalities and the use of contraceptives may contribute to sinus thrombosis, leading to the development of the second remote DAVF after treatment of CSDAVFs.

Safety evaluation of sinus patency after stereotactic radiosurgery for transverse-sigmoid sinus dural arteriovenous fistulas: implications of treatment options for patients with Borden type I fistulas.

This study aimed to assess the efficacy and safety of stereotactic radiosurgery (SRS) in treating transverse-sigmoid sinus dural arteriovenous fistulas (TSS DAVFs), and to investigate post-SRS sinus patency, focusing on the risk factors associated with treated sinus occlusion. Data from 34 patients treated with SRS between January 2006 and April 2023 were analyzed. Detailed angioarchitecture was confirmed using digital subtraction angiography before SRS. Angiography of the ipsilateral internal carotid artery and vertebral artery was performed to evaluate whether the involved side of the TSS was used for normal venous drainage. TSS stenosis was defined as sinus diameter < 50% of the normal proximal diameter. DAVF shunt obliteration, TSS occlusion, neurological status, and adverse events were also evaluated. Of the 34 patients, 21 had Borden type I and 14 had Borden type II DAVFs. The median age at SRS was 64 years (interquartile range 54-71 years), and the follow-up period was 31 months (interquartile range 15-94 months). Complete shunt obliteration was achieved in 24 (70.6%) patients. The cumulative 2-, 3-, and 5-year shunt obliteration rates were 49.6%, 71.2%, and 86.0%, respectively. Borden type I had higher obliteration rates (60.5%, 83.1%, and 94.4%, respectively) than Borden type II (41.7%, 51.4%, and 75.7%, respectively; p = 0.034). TSS occlusion occurred in 5 patients (14.7%). The cumulative 1-, 5-, and 10-year TSS occlusion rates were 2.9%, 8.3%, and 23.6%, respectively, across the entire cohort. All occlusions occurred exclusively in the sinuses that were not used for normal venous drainage. Cox proportional analyses revealed that TSS stenosis and the sinus not being used for normal venous drainage were significantly associated with a greater risk of TSS occlusion after SRS (HR 9.44, 95% CI 1.01-77.13; p = 0.049). SRS is effective and safe for TSS DAVF and results in favorable shunt obliteration, symptom improvement, and low complication rates. TSS occlusion after SRS is asymptomatic and is limited to sinuses that are not used for normal venous drainage.

Cerebral dural arteriovenous fistulas in patients with PTEN-related hamartoma tumor syndrome.

Central nervous system (CNS) dural arteriovenous fistulas (DAVF) have been reported in PTEN-related hamartoma tumor syndrome (PHTS). However, PHTS-associated DAVF remain an underexplored field of the PHTS clinical landscape. Here, we studied cases with a PTEN pathogenic variant identified between 2007 and 2020 in our laboratory (n = 58), and for whom brain imaging was available. Two patients had DAVF (2/58, 3.4%), both presenting at advanced stages: a 34-year-old man with a left lateral sinus DAVF at immediate risk of hemorrhage, and a 21-year-old woman with acute intracranial hypertension due to a torcular DAVF. Interestingly, not all patients had 3D TOF/MRA, the optimal sequences to detect DAVF. Early diagnosis of DAVF can be lifesaving, and is easier to treat compared to developed, proliferative, or complex lesions. As a result, one should consider brain MRI with 3D TOF/MRA in PHTS patients at genetic diagnosis, with subsequent surveillance on a case-by-case basis.

Isolated sinus dural arteriovenous fistulas: a single-center experience in 44 patients.

Isolated sinus dural arteriovenous fistulas (DAVFs) constitute a rare and distinctive subtype of DAVF, typically found in small case numbers or case reports. The optimal treatment for this DAVF type remains unclear. This study aims to further detail the treatment outcomes of isolated sinus DAVFs in a sizable cohort from a single center. A retrospective study was undertaken on a consecutive series of patients with isolated sinus DAVFs treated at a single institution from 2002 to 2022. The article delineates the clinical presentation, angiographic features, treatment strategy, clinical and angiographic outcomes, and complications. The cohort consisted of 31 males and 13 females, with an average age of 52.0 ± 15.5years (range, 16-83). The success rate for trans-arterial embolization (TAE) was 97.3% (36/37). Transvenous embolization (TVE) with the reopening technique was successful in 3 of 4 patients (75.0%). Two open burr-hole TVE cases (66.7%, 2/3) and one surgery (100%) resulted in immediate complete closure of the fistula. Immediate complete occlusion was achieved in 93.2% (41/44) of cases. There was one major complication (2.3%, 1/44) and two fistulas recurred (9.5%, 2/21). The majority of isolated sinus DAVFs can be effectively treated with TAE using Onyx. TVE and surgery serve as alternative techniques when arterial access is deemed inappropriate or when complete occlusion cannot be attained with TAE. Complete embolization of isolated sinus DAVFs by TAE can typically be achieved without delay.

Intraorbital Arteriovenous Fistulas: Case Series and Systematic Review.

Intraorbital arteriovenous fistulas (AVFs) are an extremely rare subtype of intracranial fistula with ophthalmic symptoms similar to cavernous sinus dural AVFs or carotid cavernous fistulas but worse visual outcomes. Here, we present a case series and thorough systematic review on intraorbital AVFs to demonstrate treatment modalities and address this rare type of AVF. We conducted a retrospective study at a single center, in which we identified all cases of intraorbital AVFs that occurred between 2002 and 2022. We collected and analyzed data on demographics, fistula characteristics, treatment methods, clinical outcomes, and fistula closure. In addition, we conducted a systematic review of intraorbital AVFs. Seven cases in our center and 41 cases of intraorbital AVFs reported in the 35 articles were identified. At our center, transarterial embolization (TAE) (42.9%) alone resulted in immediate complete occlusion in 3 cases. Transvenous embolization (14.3%) resulted in one case of immediate complete occlusion. In 2 cases, surgery (28.6%) resulted in immediate complete occlusion. In one case, conservative treatment (14.3%) was used, and the fistula was eventually spontaneously occluded. Immediate complete occlusion rate was 85.7%. One blindness occurred (14.3%). In the literature reported, 3 cases (60%) of retinal artery occlusion were reported when performing TAE via the ophthalmic artery. Two fistulas recurred as reported. In 33 (80.5%) patients, the fistula was finally completely occluded. TAE via the ophthalmic artery carries a high risk of blindness and a low cure rate. Transvenous techniques such as conventional transvenous routes, surgical exposure, or direct puncture of the drainage vein have been used as the first line of treatment for intraorbital AVFs.

Middle cranial fossa non-cavernous sinus dural arteriovenous fistulas: 20years of experience.

Non-cavernous sinus (CS) dural arteriovenous fistulas (DAVFs) involving the sphenoid bone are rare entities that are easily confused with one another due to the complex structure and high variability of the venous system around the middle cranial fossa. We present a large retrospective study on middle cranial fossa non-CS DAVFs and review the literature on DAVF treatment in this location as well as relative anatomy. 15 patients had DAVFs involving the lesser sphenoid wing and 11 patients had DAVFs involving the greater sphenoid wing. Six patients presented with intracranial hemorrhage or subarachnoid hemorrhage (23.1%, 6/26). The most common symptoms were eye symptoms (38.5%, 10/26). Nineteen patients were treated with trans-arterial embolization (TAE) using liquid embolic agents and two patients were treated with transvenous embolization (TVE) using Onyx or in combination with coils. Surgical disconnection of the drainage veins was performed in five patients, with three cases experiencing unsuccessful TAE. Anatomic cure was achieved in 92.3% of the patients (24/26). Twelve patients had DSA and clinical follow-up from 3 to 27months. There was one recurrence (8.3%) of the fistula in the patient two months after the initial complete occlusion. The majority of patients can be cured endovascularly. Laterocavernous sinus DAVFs may not be embolized by transvenous approach via the cavernous sinus because there is often no connection between them in most patients. A small percentage of patients may require surgical ligation to be cured.

Facilitated Retrograde Access via the Facial Vein for Transvenous Embolization of the Cavernous Sinus Dural Arteriovenous Fistula with Isolated Ophthalmic Venous Drainage.

Management of cavernous sinus dural arteriovenous fistula (CSDAVF) continues to present significant challenges, particularly when the inferior petrosal sinus is thrombosed, collapsed, or angiographically invisible. In this study, we introduce facilitated retrograde access via the facial vein, which is employed in the transvenous embolization of CSDAVF with isolated superior ophthalmic venous drainage. We also present illustrative cases and technical points.

A Case of Dural Arteriovenous Fistula Following Cerebral Venous Sinus Thrombosis Associated with the COVID-19 Vaccine.

Cerebral venous sinus thrombosis (CVST) is one of the rare and severe complications of coronavirus disease 2019 (COVID-19) vaccines. CVST has also been reported to develop into dural arteriovenous fistula; however, there were no reports of dural arteriovenous fistula associated with COVID-19 vaccine-induced cerebral venous sinus thrombosis. Here, we describe a rare case of a transverse-sigmoid sinus dural arteriovenous fistula followed by CVST due to COVID-19 vaccination. A 70-year-old patient presented with headache five days after receiving a second dose of COVID-19 vaccine. MRI showed a CVST in the superior sagittal sinus, left transverse sinus, and left sigmoid sinus. His headache improved after the administration of anticoagulant therapy. Six months later, a similar headache recurred, and cerebral angiography demonstrated a dural arteriovenous fistula in the left transverse sigmoid sinus and convexity dural arteriovenous fistulas in the left parietal cortex. The patient was treated twice with two sessions of transarterial embolization, and the shunts were completely occluded. His symptoms improved, and he was discharged with a modified Rankin Scale score of 0. Dural arteriovenous fistula can develop after CVST in association with COVID-19 vaccination.

An isolated Sinus Intracranial Dural Arteriovenous Fistula with Unusual Drainage Pattern

Isolated sinus dural arteriovenous fistulas (DAVFs) involve a dural sinus with occlusion on both sides of the diseased sinus segment. Because of venous drainage refluxing from the isolated sinus into the cortical veins, all isolated sinus DAVFs are Borden type III or Cognard type Ⅲ/Ⅳ. Venous drainage typically involves temporo-occipital cortical veins or the superior petrosal sinus and tributaries of the petrosal vein. However, drainage veins involving the perimedullary venous system are extremely rare. Here, we present a case of Cognard type V isolated sinus DAVF successfully treated with balloon catheter and Onyx.

Transarterial embolization of sinus dural arteriovenous fistula using non-adhesive liquid embolic material.

Objective: The objective is to report our experience of transarterial embolization of sinus dural arteriovenous fistula (DAVF) using non-adhesive liquid embolic material.Materials and methods: In 3 cases of Borden type II sinus DAVFs, a Copernic balloon was used to protect sagittal sinus in one patient, palliative Onyx embolization was performed to protect transverse sinus in one patient and EVAL/DMSO/ethanol mixture (EVAL, SUCCESS, Shandong, China) was used in the last patient.Results: Two Borden type II DAVFs were changed into type I DAVF and one was cured. The dural sinus was patent after successful Onyx embolization in 3 cases resulting in well patient recovery. There were no treatment-related events.Conclusion: Transarterial embolization of sinus DAVF using non-adhesive liquid embolic material could be effective and safe with sinus protection techniques.

Endovascular management of cavernous sinus dural arteriovenous fistula: A single-center experience

ObjectiveThe purpose of this study was to evaluate the single-center experience with endovascular management of cavernous sinus dural arteriovenous fistula (CS-DAVF). MethodsFrom October 2018 to April 2020, a total of 54 patients with CS-DAVF underwent endovascular treatment at our center. Demographic information, clinical symptoms, and lesion characteristics were noted. Medical records were reviewed to assess changes in clinical status, complications, and recurrence following treatment. The correlation between patient characteristics, fistula characteristics, and treatment outcomes was analyzed. ResultsClinical signs and symptoms included chemosis (81.5%), exophthalmos (42,6%), cranial nerve palsy/diplopia (11.1%), increased intraocular pressure (74.1%), and impaired vision (42,6%). Cortical venous drainage was identified in 29.6% of the patients. Transvenous embolization (alone or in conjunction with transarterial embolization) was the treatment of choice in most patients. Partial transarterial embolization alone was carried out in only 1.8%. Complete occlusion of the fistula was achieved in 81.48%, near complete occlusion (without cortical venous drainage or ocular drainage) was achieved in 18.52%. After complete occlusion of the fistula, no recurrence was observed. ConclusionTransvenous embolization is a highly efficient and safe treatment for CS-DAVF. In a majority of patients, a significant and permanent improvement in clinical signs and symptoms can be achieved.

A cavernous sinus dural arteriovenous fistula treated by direct puncture of the superior ophthalmic vein with craniotomy: illustrative case.

The authors report a case of symptomatic cavernous sinus (CS) dural arteriovenous fistula (dAVF) that was successfully treated using direct puncture of the superior ophthalmic vein (SOV) with craniotomy. CS dAVF is commonly treated using transvenous embolization (TVE), with the most common access route via the inferior petrosal sinus (IPS). However, this route is sometimes unavailable because of an occluded, hypoplastic, aplastic, or tortuous IPS. The SOV is an alternative, albeit tortuous and long, route to the CS; therefore, direct SOV puncture is occasionally performed. Direct SOV puncture is mostly percutaneous; however, in this case, it was difficult because of subcutaneous SOV narrowing. As the patient experienced increased intraocular pressure, decreased vision, and eye movement disorders, CS embolization was performed via direct puncture with a craniotomy because of other access difficulties. Several reports have described CS dAVF in patients receiving endovascular treatment via direct SOV puncture using a transorbital approach. However, to the best of the authors' knowledge, this is the first reported case of a CS dAVF treated using TVE with craniotomy. This approach is useful when the SOV cannot be reached intravenously and its distance from the epidermis is long.

Seizure as the first symptom of cavernous sinus dural arteriovenous fistula: A case report and literature review

Cavernous sinus dural arteriovenous fistula (CS-DAVF) is an abnormal arteriovenous communication associated with a variety of clinical manifestations. The previous literature has rarely reported the occurrence of CS-DAVF with seizures and cerebral hemorrhage, signaling the need for more case reports and literature review in this area. A 62-year-old Chinese female presented with a paroxysmal loss of consciousness, accompanied with involuntary eye movement to the left, chewing issues, salivation at the right corner of the mouth, and bit tongue. The brain computed tomography revealed that the left temporal lobe was hemorrhagic. Brain scan and contrast-enhanced magnetic resonance imaging showed diffuse meningeal enhancement and lesions in the left frontoparietal temporal lobe, insular lobe, and hippocampal head region. Electroencephalography demonstrated continuous emission of spike and slow waves in the left hemisphere. With the aid of digital subtraction angiography, the patient was confirmed with a diagnosis of CS-DAVF draining into the ipsilateral cavernous sinus, intercavernous sinus, contralateral cavernous sinus, left superior ophthalmic vein, left lateral fissure vein, and left pterygoid venous plexus. The fistula was closed with interventional embolization through the femoral vein, and immediate angiography showed complete resolution of CS-DAVF after operation. The patient did not manifest any post-operative complications. This case highlights that the prevention of epilepsy, cerebral hemorrhage, and other serious complications is extremely important for good prognosis, especially in some patients presenting with serious clinical symptoms. It also sheds light on the necessity to consider the diagnosis of CS-DAVF if seizures, although extremely rare, are present.

Dural Arteriovenous Fistulas With or Without Cerebral Venous Thrombosis: A Cross-Sectional Analysis of 511 Patients.

Recent studies suggest a bidirectional relationship of dural arteriovenous fistula (DAVF) with cerebral venous thrombosis (CVT). We aimed to compare the characteristics of patients with DAVF with or without CVT and to analyze the risk factors for the coexistence of CVT in a DAVF population. A total of 511 adult patients with DAVF were enrolled consecutively in our hospital from February 2019 through November 2022. Demographic data, clinical manifestations, and imaging characteristics were reviewed in detail. The patients with DAVF were divided into two groups: DAVF with CVT (DAVF-CVT) group and without CVT (DAVF alone) group. Univariate logistic regression and multivariate logistic regression were used to analyze the risk factors for the coexistence of CVT and DAVF. CVT was found in 19.8% of patients with DAVF. In univariate analysis, compared with the DAVF-alone group, the DAVF-CVT group was more likely to have tinnitus ( P = .001), blurred vision ( P < .001), visual field loss ( P = .001), focal neurological deficits ( P = .002), seizures ( P = .008), and cognitive impairment ( P = .046) and less likely to have spinal cord/brain stem dysfunction ( P = .004). In addition, there were significant differences in age ( P = .009), sex ( P = .019), the occurrence of venous cerebral infarction ( P = .001), and DAVF location ( P < .001) between the two groups. Furthermore, multivariate analysis showed that blurred vision, venous cerebral infarction, large sinus DAVF, and multiple DAVF were risk factors for the coexistence of CVT in patients with DAVF, with the odds ratio of 2.416 (95% CI 1.267-4.606, P = .007), 6.018 (95% CI 1.289-28.100, P = .022), 5.801 (95% CI 2.494-13.496, P < .001), and 5.640 (95% CI 2.122-14.989, P = .001), respectively. CVT occurred in approximately one fifth of patients with DAVF. Blurred vision, venous cerebral infarction, large sinus DAVF, and multiple DAVF may be the risk factors for predicting the coexistence of CVT in patients with DAVF.