New concept in cavernous sinus dural arteriovenous fistula - Correlation with presenting symptom and venous drainage patterns

Background and Purpose-An extradurally located cavernous sinus dural arteriovenous fistula (CSDAVF) exhibits different clinical behavior from other dural arteriovenous fistulas (DAVFs) located between 2 dural leaves. The aim of this study is to define angiographic types of CSDAVF associated with presenting symptom (Sx) and venous drainage patterns. Methods-CSDAVFs during a mean of 23-month follow-up period of 58 patients ( 17 to 73 years, male: female ratio = 8:50) were retrospectively analyzed. The 3 types of CSDAF, ie, proliferative ( PT), restrictive (RT), and late restrictive (LRT) types, were categorized by the degrees and patterns of prominent arteriovenous shunt as well as venous flow. The status of the venous connection with CS and the presenting Sx patterns classified as orbital (OrbSxP), ocular (OcuSxP), cavernous (CavSxP), and cerebral (CerSxP) were associated with angiographic types as well as symptom onset, age, and gender. Correlations of discrete and categorical variables were statistically analyzed using the chi(2) or Fisher exact test. Results-PT (n = 23) and RT (n = 23) of CSDAVF were more common than LRT (n = 12) (P = 0.016) in patients with younger than 65 years and were related to OrbSxP (P = 0.015) and CavSxP (P = 0.038) in contrast to LRT to OcuSxP (P = 0.004). Early onset of Sxs was related to the OrbSxP (P = 0.08) and CavSxP (P < 0.001). CerSxP (5%) was noted in RT or LRT. OrbSxP was related to the superior ophthalmic venous drainage (P = 0.026) and CavSxP to the inferior petrosal sinus (P = 0.046) and posterior fossa venous drainages (P = 0.014). Seven patients revealed chronological progression of CSDAVF from PT to LRT and even to complete healing. Conclusions-CSDAVF presents as 3 distinctive angiographic types and is associated with presenting Sxs and venous drainage patterns.