Intracranial hemorrhage from dural arteriovenous fistulas

Clinical features and outcome

David Daniels, Ananth K. Vellimana, Gregory J. Zipfel, Giuseppe Lanzino

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Object. In this paper the authors' goal was to review the clinical features and outcome of patients with intracranial dural arteriovenous fistulas (DAVFs) who presented withhemorrhage. Methods. A retrospective study of 28 patients with DAVFs who presented with intracranial hemorrhage to 2 separate institutions was performed. The information reviewedincluded clinical presentation, location and size of hemorrhage, angiographic features, treatment, and clinical and radiologically documented outcomes. Clinical and radiological follow-up were available in 27 of 28 patients (mean follow-up 17 months). Results. The vast majority of patients were male (86%), and the most common presenting symptom was suddenonset headache. All DAVFs had cortical venous drainage, and about one-third were associated with a venous varix. The most common location was tentorial (75%). Treatment ranged from endovascular (71%), surgical (43%), Gamma Knife surgery (4%), or a combination of modalities. The majority of fistulas (75%) were completely obliterated, and most patients experienced excellent clinical outcome (71%, modified Rankin Scale score of 0 or 1). There were no complications in this series. Conclusions. Case series, including the current one, suggest that the vast majority of patients who present with intracranial hemorrhage from a DAVF are male. The most common location for DAVFs presenting with hemorrhage is tentorial. Excellent outcomes are achieved with individualized treatment, which includes various therapeutic strategies alone or in combination. Despite the hemorrhagic presentation, almost two-thirds of patients experience a full recovery with no or minimal residual symptoms.

Original languageEnglish (US)
Article numberE15
JournalNeurosurgical Focus
Volume34
Issue number5
DOIs
StatePublished - May 2013

Fingerprint

Central Nervous System Vascular Malformations
Intracranial Hemorrhages
Hemorrhage
Varicose Veins
Therapeutics
Fistula
Headache
Drainage
Retrospective Studies

Keywords

  • Cortical venous drainage
  • Embolization
  • Hemorrhage
  • Intracranial dural arteriovenous fistula
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Medicine(all)

Cite this

Intracranial hemorrhage from dural arteriovenous fistulas : Clinical features and outcome. / Daniels, David; Vellimana, Ananth K.; Zipfel, Gregory J.; Lanzino, Giuseppe.

In: Neurosurgical Focus, Vol. 34, No. 5, E15, 05.2013.

Research output: Contribution to journalArticle

Daniels, David ; Vellimana, Ananth K. ; Zipfel, Gregory J. ; Lanzino, Giuseppe. / Intracranial hemorrhage from dural arteriovenous fistulas : Clinical features and outcome. In: Neurosurgical Focus. 2013 ; Vol. 34, No. 5.
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abstract = "Object. In this paper the authors' goal was to review the clinical features and outcome of patients with intracranial dural arteriovenous fistulas (DAVFs) who presented withhemorrhage. Methods. A retrospective study of 28 patients with DAVFs who presented with intracranial hemorrhage to 2 separate institutions was performed. The information reviewedincluded clinical presentation, location and size of hemorrhage, angiographic features, treatment, and clinical and radiologically documented outcomes. Clinical and radiological follow-up were available in 27 of 28 patients (mean follow-up 17 months). Results. The vast majority of patients were male (86{\%}), and the most common presenting symptom was suddenonset headache. All DAVFs had cortical venous drainage, and about one-third were associated with a venous varix. The most common location was tentorial (75{\%}). Treatment ranged from endovascular (71{\%}), surgical (43{\%}), Gamma Knife surgery (4{\%}), or a combination of modalities. The majority of fistulas (75{\%}) were completely obliterated, and most patients experienced excellent clinical outcome (71{\%}, modified Rankin Scale score of 0 or 1). There were no complications in this series. Conclusions. Case series, including the current one, suggest that the vast majority of patients who present with intracranial hemorrhage from a DAVF are male. The most common location for DAVFs presenting with hemorrhage is tentorial. Excellent outcomes are achieved with individualized treatment, which includes various therapeutic strategies alone or in combination. Despite the hemorrhagic presentation, almost two-thirds of patients experience a full recovery with no or minimal residual symptoms.",
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