INTRACRANIAL DURAL ARTERIOVENOUS-FISTULAS WITH SPINAL VENOUS DRAINAGE- RELATION BETWEEN CLINICAL PRESENTATION AND ANGIOGRAPHIC FINDINGS

PURPOSE: To investigate why some patients with an intracranial dural a rteriovenous fistula (DAVF) with spinal venous drainage have myelopath y and others do not. METHODS: We reviewed the clinical and radiologic data for 12 patients who had a DAVF with spinal venous drainage diagno sed at our institutions from 1982 to 1995. RESULTS: Six patients had p rogressive spinal cord indications of disease (patients with myelopath y) and six others (patients without myelopathy) had cerebral indicatio ns (five had intracranial hemorrhage and one had a seizure). Cerebral angiography showed a posterior fossa DAVF with spinal venous drainage in all cases. The clinical presentation of DAVFs with spinal venous dr ainage was compared with the extent of the drainage, In patients witho ut myelopathy, the spinal venous drainage exited the intradural canal via the cervical medullary-radicular Veins and was therefore limited t o the cervical perimedullary veins. In patients with myelopathy, no me dullary-radicular Vein was seen, and the venous drainage descended alo ng the perimedullary veins of the entire spinal cord toward the conus medullaris. CONCLUSION: We found an exact relation between clinical pr esentation and venous drainage of DAVFs with spinal venous drainage. P atients had no myelopathy when the venous drainage was limited to the cervical cord; myelopathy was present when the venous drainage descend ed toward the conus medullaris.