G. Lanzino et al., ANGIOGRAPHIC CHARACTERISTICS OF DURAL ARTERIOVENOUS-MALFORMATIONS THAT PRESENT WITH INTRACRANIAL HEMORRHAGE, Acta neurochirurgica, 129(3-4), 1994, pp. 140-145
Dural arteriovenous malformations (dAVMs) are uncommon lesions that co
nstitute about 12% of all the arteriovenous malformations. Depending o
n the location and the hemodynamics of the lesion, bruit, focal neurol
ogical deficit, and visual symptoms represent the more common presenta
tion modalities. Although uncommon, intracranial hemorrhage can occur.
In the present study, we report six patients with dural arteriovenous
malformation that presented with intracranial hemorrhage. In five cas
es the hemorrhage was intraparenchymal (localized to the parietooccipi
tal area in three), while it was confined to the subarachnoid space in
the remaining one. The dAVM involved the transverse sinus in three ca
ses, was based along the tentorial incisura in two, and was at the lev
el of the torcular Herophili in one. Leptomeningeal drainage was prese
nt in all the cases. Aneurysmal dilatation of the draining vein(s) was
identified in three. Sinus stenosis/occlusion was identified in two o
f the four patients with a dAVM draining into a major dural sinus. Fou
r patients underwent preoperative embolization, and all patients had s
urgical resection of their lesions. Anatomical cure, as defined by abs
ence of any residual dAVM on postoperative angiogram, was achieved in
all six patients. We conclude that several findings such as leptomenin
geal drainage, location outside a major venous sinus, variceal dilatat
ion, sinus stenosis/occlusion increase the risk of bleeding and are fr
equently observed in those dAVMs that present with intracranial hemorr
hage. Recognition of these angiographic features is critical in planni
ng a therapeutic approach tailored to the characteristics of the indiv
idual case. When these angiographic findings are present, prompt and d
efinitive treatment is mandatory. Death from the initial hemorrhage an
d, in absence of definitive treatment, rebleeding are not uncommon.