Cranial dural fistulae are rare; when they occur, it is usually diffic
ult to detect them at an early stage, With a view to the question of p
ossible progress in diagnosis we now report on seven patients with lat
eral dural fistulae fed by branches of the external carotid artery. Th
e examination was carried out before selective arteriography using cw-
Doppler sonography and colour coded duplex sonography in combination,
Sonographic criteria for detection of hyperperfusion take account of f
low velocity as well as pulsatility. In all cases hyperperfusion of th
e external carotid artery and the common carotid artery was detected.
In most of these cases pathologic findings were also observed at the o
ccipital artery, and more rarely in the contralateral external carotid
artery or the ipsilateral vertebral artery, in addition, A possible s
ource of error arising from confusion of blood vessels was present wit
h the cw-Doppler sonography, but not for colour coded duplex sonograph
y. Therefore, cranial dural fistulae characterized by a high shunt vol
ume can be diagnosed correctly by indirect Doppler sonographic criteri
a using cw-Doppler and duplex sonography. Direct visualization of the
fistula and its nidus requires additional selective arteriography, in
the course of which endovascular embolization may be performed.