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Angioarchitectural Analysis of Arteriovenous Shunts in Dural Arteriovenous Fistulas and Its Clinical Implications

 Junhyung Kim  ;  Byung Moon Kim  ;  Keun Young Park  ;  Jae Whan Lee  ;  Yong Bae Kim  ;  Joonho Chung  ;  Dong Joon Kim 
 NEUROSURGERY, Vol.91(5) : 782-789, 2022-11 
Journal Title
Issue Date
Central Nervous System Vascular Malformations* / diagnostic imaging ; Central Nervous System Vascular Malformations* / surgery ; Cerebral Angiography ; Cranial Sinuses ; Embolization, Therapeutic* / adverse effects ; Humans ; Transverse Sinuses*
Background: Detailed understanding of the angioarchitecture of arteriovenous shunts in dural arteriovenous fistulas (DAVFs) is essential when planning endovascular treatment.

Objective: To analyze shunt patterns and their clinical implications in transverse-sigmoid sinus and superior sagittal sinus DAVFs.

Methods: A total of 48 DAVFs treated with endovascular embolization between January 2010 and June 2021 were investigated. The preprocedural and intraprocedural digital subtraction angiograms were examined to characterize the shunt patterns of DAVFs in terms of anatomic relations to the sinuses and cortical veins. Treatment characteristics and outcomes were evaluated.

Results: The shunt patterns were categorized into 4 types: the direct sinus fistula (n = 8/48, 16.7%), compartmental sinus channel (n = 14/48, 29.1%), mural channel (n = 13/48, 27.1%), and bridging vein shunt (n = 13/48, 27.1%). Mural channel lesions revealed direct (n = 4/13, 30.8%) and indirect (n = 6/13, 46.2%) cortical venous connections. Multiple shunt types were seen in 7 patients. Overall, complete or near-complete occlusion was achieved in 43 patients (89.6%) after the final embolization. Patients with mural channels received the most embolization sessions (1.4 sessions per patient). Procedural venous drainage-related complications occurred in patients with multiple shunt types including mural channel shunts (n = 3). All bridging vein shunts were completely occluded during a single transarterial embolization session.

Conclusion: The 4 shunt patterns of DAVFs demonstrate distinct characteristics for the fistula, sinus and cortical vein connection. Meticulous analysis of the angioarchitectural characteristics and clinical implications is warranted for safe and effective treatment.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0003-2262-7157
Kim, Junhyung(김준형) ORCID logo https://orcid.org/0000-0002-8908-978X
Park, Keun Young(박근영)
Lee, Jae Whan(이재환)
Chung, Joon Ho(정준호)
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