Factors influencing the prognosis in intracranial dural arteriovenous fistulas with perimedullary drainage

World Neurosurg. 2013 Jan;79(1):182-91. doi: 10.1016/j.wneu.2012.09.012. Epub 2012 Sep 23.


Objective: Intracranial dural arteriovenous fistulas with perimedullary venous drainage (IDAVFPD) are classified as type V dural arteriovenous fistulas. Publications are limited to single case reports and small case series. We conducted a systematic review of the literature for patients with IDAVFPD. The aim of this study is to identify the predictive factors of poor prognosis in patients with IDAVFPD.

Methods: We present the case of a 48-year-old man who underwent surgical interruption of IDAVFPD. A complete MEDLINE search was then undertaken for all articles reporting outcomes data for IDAVFPD. According to the results we have divided the patient population into two groups: I, those patients who showed improvement after treatment, and II: those patients who did not show improvement. We conducted a comparative statistical analysis of the epidemiologic, clinical, radiologic, and therapeutic parameters between the two groups.

Results: A total of 37 articles comprising with 58 cases were included for analysis with an average follow-up of 12 months. There were 36 patients in group I and 22 in group II. The average age was 57.8 years in group I and 54.3 years in group II (P=0.32). Onset of symptoms was acute or subacute in 57% of patients in group I, and in 50% of patients in group II (P=0.62). Bulbar signs were present in 28% of cases in group I and in 36% of cases in group II (P=0.49). Hyperintensity of the brainstem on T2-weighted sequence magnetic resonance imaging was more common in patients in group II (78%) compared with patients in group I (45%) (P=0.012). Patients who underwent surgical procedure have shown good outcomes compared to patients treated with endovascular approach (P=0.039).

Conclusions: The poor outcomes were correlated to the presence of brainstem signal abnormalities on magnetic resonance imaging, whereas the prognosis does not depend on age, sex, clinical presentation, or anatomic characteristics of the fistula.

Publication types

  • Case Reports
  • Review
  • Systematic Review

MeSH terms

  • Central Nervous System Vascular Malformations / diagnostic imaging
  • Central Nervous System Vascular Malformations / pathology*
  • Central Nervous System Vascular Malformations / physiopathology*
  • Cerebral Angiography
  • Cerebrovascular Circulation / physiology
  • Diagnosis, Differential
  • Drainage
  • Humans
  • Intracranial Arteriovenous Malformations / diagnostic imaging
  • Intracranial Arteriovenous Malformations / pathology*
  • Intracranial Arteriovenous Malformations / physiopathology*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Prognosis