Ipsilateral Intracranial Edema Associated with Drainage Patterns of Dural Arteriovenous Fistula

• Published in: Journal of stroke and cerebrovascular diseases 2014-05, Vol.23 (5), p.1094-1098
• Main Authors: Dong, Yi, MD, Cao, Wenjie, MD, Huang, Lei, MD, Li, Linxin, MD, Zhang, Yue, MD, Dong, Qiang, MD, PhD, Zhang, Xiaolong, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; anatomic veins; Angiography, Digital Subtraction; Brain Edema - diagnosis; Brain Edema - etiology; Brain Edema - physiopathology; Cardiovascular; Central Nervous System Vascular Malformations - complications; Central Nervous System Vascular Malformations - diagnosis; Central Nervous System Vascular Malformations - physiopathology; Cerebral Angiography - methods; Cerebral Veins - diagnostic imaging; Cerebral Veins - physiopathology; Cerebrovascular Circulation; DAVF; edema; Female; Humans; Male; Middle Aged; Neurology; Phlebography; Predictive Value of Tests; reflux flow; Retrospective Studies; Risk Factors; Severity of Illness Index
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2013.09.016

Background Massive ipsilateral edema in patients with cerebral dural arteriovenous fistula (DAVF) is poorly documented. The present study better characterizes this condition through assessment of venous anatomy and potential underlying mechanisms. Methods One hundred and two consecutive patients diagnosed with DAVF and admitted to the Huashan Hospital from 2006 to 2012 were retrospectively reviewed for the clinical and radiologic data, and those with ipsilateral edema were recruited. An edema scale was calculated from the locations with edema on magnetic resonance imaging. We created a reflux anatomic venous scale (RAVS, including veins of Labbe, Sylvian, and Troland) based on DSA. Two experienced interventional neuroradiologists independently assessed the images and then reached consensus. The Spearman nonparametric rank correlation was performed to analyze the correlation between edema scale and RAVS. Results Seven patients (mean 61 ± 13 years; 4 men:3 women) with ipsilateral intracranial edema were finally included. DAVF in transverse sinus with reflux flow initially in vein of the Labbe was seen in all patients. Increased edema scale was significantly correlated with increased RAVS (Spearman rho = .856, P  = .014). Conclusion The present study indicated that severe ipsilateral edema, with reflux flow initially in vein of the Labbe, was associated with the increased number of reflux anatomic veins in transverse sinus DAVF.