Dural arteriovenous fistulas as a cause of intracranial hypertension due to impairment of cranial venous outflow

被引:132
作者
Cognard, C
Casasco, A
Toevi, M
Houdart, E
Chiras, J
Merland, JJ
机构
[1] Hop Purpan, Serv Neuroradiol, F-31059 Toulouse, France
[2] Hop La Pitie Salpetriere, Serv Neuroradiol, Paris, France
[3] Karolinska Hosp, Dept Neuroradiol, S-10401 Stockholm, Sweden
[4] Hop Lariboisiere, Serv Neuroradiol, F-75010 Paris, France
关键词
arteriovenous fistula; benign intracranial hypertension; dural fistula; endovascular treatment; embolisation; intracranial hypertension;
D O I
10.1136/jnnp.65.3.308
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objectives - A retrospective study was carried out on 13 patients with intracranial dural arteriovenous fistulas (DAVFs) who presented with isolated or associated signs of intracranial hypertension. Methods - Nine patients presented with symptoms of intracranial hypertension at the time of diagnosis. Ocular fundoscopy available in 12 patients showed bilateral papilloedema in eight and optic disk atrophy in four. Clinical evolution was particularly noticeable in five patients because of chronic (two patients) or acute (after lumbar shunting or puncture: three patients, one death) tonsillar herniation. Results - Two patients had a type I fistula (drainage into a sinus, with a normal antegrade flow direction). The remaining 11 had type II fistulas (drainage into a sinus, with abnormal retrograde venous drainage into sinuses or cortical veins). Stenosis or thrombosis of the sinus(es) distal to the fistula was present in five patients. The cerebral venous drainage was abnormal in all patients. Conclusion - Type II (and some type I) DAVFs may present as isolated intracranial hypertension mimicking benign intracranial hypertension. Normal cerebral angiography should be added as a fifth criterion of benign intracranial hypertension. The cerebral venous drainage pattern must be carefully studied by contralateral carotid and vertebral artery injections to correctly evaluate the impairment of the cerebral venous outflow. Lumbar CSF diversion (puncture or shunting) may induce acute tonsillar herniation and should be avoided absolutely. DAVF may induce intracranial hypertension, which has a poor long term prognosis and may lead to an important loss of visual acuity and chronic tonsillar herniation. Consequently, patients with intracranial hypertension must be treated, even agressively, to obliterate the fistula or at least to reduce the arterial flow and to restore a normal cerebral venous drainage. The endovascular treatment may associate arterial or transvenous embolisation and/or surgery. Patients in whom the fistula is not obliterated after an endovascular therapeutic procedure, need continous clinical and angiographical follow up.
引用
收藏
页码:308 / 316
页数:9
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