Dural arteriovenous fistulas involving the superior sagittal sinus: Acute presentation with intracranial hemorrhage

Robert W. Hurst, Paul Marcotte, Eric C. Raps, Eugene S. Flamm

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BACKGROUND: Intracranial dural arteriovenous fistulas (DAVF) usually drain directly into large dural venous sinuses. Intracranial hemorrhage is therefore unusual with these lesions. Certain subgroups of DAVF may drain into cortical veins causing engorgement, venous hypertension, and hemorrhage. The region of the superior sagittal sinus (SSS), while an unusual location for DAVF, is one in which drainage typically occurs directly into cortical veins. METHODS: We report on three patients with dural arteriovenous malformations of the superior sagittal sinus, all of whom presented with intracranial hemorrhage. Intraparenchymal hemorrhage in two of the cases was surrounded by excessive edema, suggesting the presence of underlying venous hypertension. RESULTS: Interventional treatment of all three of the lesions was accomplished at the time of diagnostic angiography. CONCLUSIONS: SSS DAVF is an uncommon lesion whose presentation is usually with intracranial hemorrhage. Large amounts of edema surrounding an acute hemorrhage may suggest the diagnosis, which usually requires confirmation with angiography. Treatment of SSS DAVF can often be accomplished at the time of diagnostic angiography by embolization using interventional neuroradiologic techniques. When endovascular obliteration of the fistula is not feasible or is incomplete, surgical resection of the DAVF site may be achieved without difficulty.

Original languageEnglish (US)
Pages (from-to)42-46
Number of pages5
JournalSurgical Neurology
Volume49
Issue number1
DOIs
StatePublished - Jan 1998
Externally publishedYes

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Superior Sagittal Sinus
Central Nervous System Vascular Malformations
Intracranial Hemorrhages
Angiography
Hemorrhage
Veins
Edema
Hypertension
Arteriovenous Malformations
Hyperemia
Fistula
Drainage
Therapeutics

Keywords

  • Dural arteriovenous fistula
  • Embolization
  • Interventional neuroradiology

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Dural arteriovenous fistulas involving the superior sagittal sinus : Acute presentation with intracranial hemorrhage. / Hurst, Robert W.; Marcotte, Paul; Raps, Eric C.; Flamm, Eugene S.

In: Surgical Neurology, Vol. 49, No. 1, 01.1998, p. 42-46.

Research output: Contribution to journalArticle

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AB - BACKGROUND: Intracranial dural arteriovenous fistulas (DAVF) usually drain directly into large dural venous sinuses. Intracranial hemorrhage is therefore unusual with these lesions. Certain subgroups of DAVF may drain into cortical veins causing engorgement, venous hypertension, and hemorrhage. The region of the superior sagittal sinus (SSS), while an unusual location for DAVF, is one in which drainage typically occurs directly into cortical veins. METHODS: We report on three patients with dural arteriovenous malformations of the superior sagittal sinus, all of whom presented with intracranial hemorrhage. Intraparenchymal hemorrhage in two of the cases was surrounded by excessive edema, suggesting the presence of underlying venous hypertension. RESULTS: Interventional treatment of all three of the lesions was accomplished at the time of diagnostic angiography. CONCLUSIONS: SSS DAVF is an uncommon lesion whose presentation is usually with intracranial hemorrhage. Large amounts of edema surrounding an acute hemorrhage may suggest the diagnosis, which usually requires confirmation with angiography. Treatment of SSS DAVF can often be accomplished at the time of diagnostic angiography by embolization using interventional neuroradiologic techniques. When endovascular obliteration of the fistula is not feasible or is incomplete, surgical resection of the DAVF site may be achieved without difficulty.

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