DURAL ARTERIOVENOUS-FISTULAS INVOLVING THE SUPERIOR SAGITTAL SINUS - ACUTE PRESENTATION WITH INTRACRANIAL HEMORRHAGE

BACKGROUND Intracranial dural arteriovenous fistulas (DAVF) usually dr ain directly into large dural venous sinuses. Intracranial hemorrhage is therefore unusual with these lesions. Certain subgroups of DAVF may drain into cortical veins causing engorgement, venous hypertension, a nd hemorrhage. The region of the superior sagittal sinus (SSS), while an unusual location for DAVF, is one in which drainage typically occur s directly into cortical veins. METHODS We report on three patients wi th dural arteriovenous malformations of the superior sagittal sinus, a ll of whom presented with intracranial hemorrhage. Intraparenchymal he morrhage in two of the cases was surrounded by excessive edema, sugges ting the presence of underlying venous hypertension. RESULTS intervent ional treatment of all three of the lesions was accomplished at the ti me of diagnostic angiography. CONCLUSIONS SSS DAVF is an uncommon lesi on whose presentation is usually with intracranial hemorrhage. Large a mounts of edema surrounding an acute hemorrhage may suggest the diagno sis, which usually requires confirmation with angiography. Treatment o f SSS DAVF can often be accomplished at the time of diagnostic angiogr aphy by embolization using interventional neuroradiologic techniques. When endovascular obliteration of the fistula is not feasible or is in complete, surgical resection of the DAVF site may be achieved without difficulty. (C) 1998 by Elsevier Science Inc.