ANGIOGRAPHIC CHARACTERISTICS OF DURAL ARTERIOVENOUS-MALFORMATIONS THAT PRESENT WITH INTRACRANIAL HEMORRHAGE

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.