Clinical Characteristics of Cerebral Dural Arteriovenous Malformations

Kwon, O Ki; Han, Dae Hee; Oh, Chang Wan; Han, Moon Hee; Chung, Young Seob; Wang, Kyu Chang; Cho, Byung Kyu

Abstract

Intracranial dural arteriovenous malformation(AVM) is an uncommon neurosurgical condition; in particular, it has been infrequently reported in Korea. To understand the general clinical characteristics of dural AVMs, the authors reviewed 41 cases and analysed the factors affecting hemorrhage of dural AVMs. Since 1980 we have encountered 320 pial and 41 dural AVM, a ratio of 7.8 to 1. The age of these patients ranged from 3 months to 70 years, the most common being the 6th decade, and female exceeded males by a ratio of 1.56 to 1. All lesions except one was single, and symptoms were related to it's location and the venous drainage pattern. The most common location was the cavernous sinus, accounting for about 70% of cases, so the most common clinical symptoms of dural AVMs were ocular, namely-proptosis and chemosis. The next was tinnitus found in transverse/sigmoid sinus dural AVMs. Intracranial hemorrhage was seen in six cases(14.6%), the primary cause of hemorrhage was retrograde intracranial venous drainage(p=0.001), and no hemorrhage was observed in cases with no intracranial venous drainage. And intracranial hemorrhage was more frequent in transverse/sigmoid than cavernous sinus dural AVMs, and this was so even where there was intracranial venous drainage(p<0.001). However two of 28 patients with cavernous dural AVMs became blind in one eye, demonstrating that in such patients, the clinical course could be aggressvie. The majority of cases were treated by endovascular therapy: surgical excision was performed in only one patient with tentorial dural AVM. Eight patients were treated conservatively. Three died of hemorrhage, 3 who had had fixed deficit had neurologic deficits even after a definite treatment, and 35(85%) showed clinical improvement. During intervention, there was one hemorrhagic complication, due to obstruction of venous outflow with embolic materials.