Angiographic characteristics of dural arteriovenous malformations that present with intracranial hemorrhage. 1994

G Lanzino, and M E Jensen, and G L Kongable, and N F Kassell
Department of Neurological Surgery, University of Virginia Health Sciences Center, Charlottesville.

Dural arteriovenous malformations (dAVMs) are uncommon lesions that constitute about 12% of all the arteriovenous malformations. Depending on the location and the hemodynamics of the lesion, bruit, focal neurological deficit, and visual symptoms represent the more common presentation 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 cases the hemorrhage was intraparenchymal (localized to the parietooccipital area in three), while it was confined to the subarachnoid space in the remaining one. The dAVM involved the transverse sinus in three cases, was based along the tentorial incisura in two, and was at the level of the torcular Herophili in one. Leptomeningeal drainage was present in all the cases. Aneurysmal dilatation of the draining vein(s) was identified in three. Sinus stenosis/occlusion was identified in two of the four patients with a dAVM draining into a major dural sinus. Four patients underwent pre-operative embolization, and all patients had surgical resection of their lesions. Anatomical cure, as defined by absence of any residual dAVM on postoperative angiogram, was achieved in all six patients. We conclude that several findings such as leptomeningeal drainage, location outside a major venous sinus, variceal dilatation, sinus stenosis/occlusion increase the risk of bleeding and are frequently observed in those dAVMs that present with intracranial hemorrhage. Recognition of these angiographic features is critical in planning a therapeutic approach tailored to the characteristics of the individual case. When these angiographic findings are present, prompt and definitive treatment is mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D002532 Intracranial Aneurysm Abnormal outpouching in the wall of intracranial blood vessels. Most common are the saccular (berry) aneurysms located at branch points in CIRCLE OF WILLIS at the base of the brain. Vessel rupture results in SUBARACHNOID HEMORRHAGE or INTRACRANIAL HEMORRHAGES. Giant aneurysms (>2.5 cm in diameter) may compress adjacent structures, including the OCULOMOTOR NERVE. (From Adams et al., Principles of Neurology, 6th ed, p841) Aneurysm, Cerebral,Aneurysm, Intracranial,Basilar Artery Aneurysm,Berry Aneurysm,Brain Aneurysm,Cerebral Aneurysm,Giant Intracranial Aneurysm,Mycotic Aneurysm, Intracranial,Aneurysm, Anterior Cerebral Artery,Aneurysm, Anterior Communicating Artery,Aneurysm, Basilar Artery,Aneurysm, Middle Cerebral Artery,Aneurysm, Posterior Cerebral Artery,Aneurysm, Posterior Communicating Artery,Anterior Cerebral Artery Aneurysm,Anterior Communicating Artery Aneurysm,Middle Cerebral Artery Aneurysm,Posterior Cerebral Artery Aneurysm,Posterior Communicating Artery Aneurysm,Aneurysm, Berry,Aneurysm, Brain,Aneurysm, Giant Intracranial,Aneurysm, Intracranial Mycotic,Aneurysms, Basilar Artery,Aneurysms, Berry,Aneurysms, Brain,Aneurysms, Cerebral,Aneurysms, Giant Intracranial,Aneurysms, Intracranial,Aneurysms, Intracranial Mycotic,Artery Aneurysm, Basilar,Artery Aneurysms, Basilar,Basilar Artery Aneurysms,Berry Aneurysms,Brain Aneurysms,Cerebral Aneurysms,Giant Intracranial Aneurysms,Intracranial Aneurysm, Giant,Intracranial Aneurysms,Intracranial Aneurysms, Giant,Intracranial Mycotic Aneurysm,Intracranial Mycotic Aneurysms,Mycotic Aneurysms, Intracranial
D002533 Cerebral Angiography Radiography of the vascular system of the brain after injection of a contrast medium. Angiography, Cerebral,Angiographies, Cerebral,Cerebral Angiographies
D002538 Intracranial Arteriovenous Malformations Congenital vascular anomalies in the brain characterized by direct communication between an artery and a vein without passing through the CAPILLARIES. The locations and size of the shunts determine the symptoms including HEADACHES; SEIZURES; STROKE; INTRACRANIAL HEMORRHAGES; mass effect; and vascular steal effect. Arteriovenous Malformations, Cerebral,Intracranial Arteriovenous Malformations, Congenital,AVM (Arteriovenous Malformation) Intracranial,Cerebral Arteriovenous Malformations,Congenital Intracranial Arteriovenous Malformations,Intracranial Arteriovenous Malformation, Ruptured,Ruptured Intracranial Arteriovenous Malformation,Arteriovenous Malformation, Cerebral,Arteriovenous Malformation, Intracranial,Arteriovenous Malformations, Intracranial,Cerebral Arteriovenous Malformation,Intracranial Arteriovenous Malformation,Malformation, Cerebral Arteriovenous,Malformation, Intracranial Arteriovenous,Malformations, Cerebral Arteriovenous,Malformations, Intracranial Arteriovenous
D002543 Cerebral Hemorrhage Bleeding into one or both CEREBRAL HEMISPHERES including the BASAL GANGLIA and the CEREBRAL CORTEX. It is often associated with HYPERTENSION and CRANIOCEREBRAL TRAUMA. Brain Hemorrhage, Cerebral,Cerebral Parenchymal Hemorrhage,Hemorrhage, Cerebral,Intracerebral Hemorrhage,Hemorrhage, Cerebrum,Brain Hemorrhages, Cerebral,Cerebral Brain Hemorrhage,Cerebral Brain Hemorrhages,Cerebral Hemorrhages,Cerebral Parenchymal Hemorrhages,Cerebrum Hemorrhage,Cerebrum Hemorrhages,Hemorrhage, Cerebral Brain,Hemorrhage, Cerebral Parenchymal,Hemorrhage, Intracerebral,Hemorrhages, Cerebral,Hemorrhages, Cerebral Brain,Hemorrhages, Cerebral Parenchymal,Hemorrhages, Cerebrum,Hemorrhages, Intracerebral,Intracerebral Hemorrhages,Parenchymal Hemorrhage, Cerebral,Parenchymal Hemorrhages, Cerebral
D003131 Combined Modality Therapy The treatment of a disease or condition by several different means simultaneously or sequentially. Chemoimmunotherapy, RADIOIMMUNOTHERAPY, chemoradiotherapy, cryochemotherapy, and SALVAGE THERAPY are seen most frequently, but their combinations with each other and surgery are also used. Multimodal Treatment,Therapy, Combined Modality,Combined Modality Therapies,Modality Therapies, Combined,Modality Therapy, Combined,Multimodal Treatments,Therapies, Combined Modality,Treatment, Multimodal,Treatments, Multimodal
D004388 Dura Mater The outermost of the three MENINGES, a fibrous membrane of connective tissue that covers the brain and the spinal cord. Falx Cerebelli,Falx Cerebri,Pachymeninx,Tentorium Cerebelli
D004621 Embolization, Therapeutic A method of hemostasis utilizing various agents such as Gelfoam, silastic, metal, glass, or plastic pellets, autologous clot, fat, and muscle as emboli. It has been used in the treatment of spinal cord and INTRACRANIAL ARTERIOVENOUS MALFORMATIONS, renal arteriovenous fistulas, gastrointestinal bleeding, epistaxis, hypersplenism, certain highly vascular tumors, traumatic rupture of blood vessels, and control of operative hemorrhage. Embolotherapy,Therapeutic Embolization,Embolizations, Therapeutic,Embolotherapies,Therapeutic Embolizations

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