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Radiology, Vol 194, 671-680, Copyright © 1995 by Radiological Society of North America

ARTICLES

Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage

C Cognard, YP Gobin, L Pierot, AL Bailly, E Houdart, A Casasco, J Chiras and JJ Merland
Service de Neuroradiologie, Hopital Lariboisiere, Paris, France.

PURPOSE: To review the symptoms and progression of dural arteriovenous fistulas (AVFs) and correlate the findings with various angiographic patterns. MATERIALS AND METHODS: Patterns of venous drainage allowed classification of dural AVFs into five types: type I, located in the main sinus, with antegrade flow; type II, in the main sinus, with reflux into the sinus (IIa), cortical veins (IIb), or both (IIa + b); type III, with direct cortical venous drainage without venous ectasia; type IV, with direct cortical venous drainage with venous ectasia; and type V, with spinal venous drainage. RESULTS: Type I dural AVFs had a benign course. In type II, reflux into the sinus induced intracranial hypertension in 20% of cases, and reflux into cortical veins induced hemorrhage in 10%. Hemorrhage was present in 40% of cases of type III dural AVFs and 65% of type IV. Type V produced progressive myelopathy in 50% of cases. CONCLUSION: This classification provides useful data for determination of the risk with each dural AVF and enables decision- making about the appropriate therapy.


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