Progressive versus Nonprogressive Intracranial Dural Arteriovenous Fistulas: Characteristics and Outcomes

Age of diagnosis for patients with progressive-versus-nonprogressive fistulas.

Multiple and progressive DAVFs. A 25-year-old female patient with large skull base DAVFs refractory to multiple endovascular treatments. She was initially diagnosed at 18 years of age and died of intracranial hemorrhage 6 years later in the setting of intractable intracranial venous hypertension. CTA images demonstrate an extensive skull base vascular abnormality with dilated cortical veins suggestive of intracranial venous hypertension.

Multiple and progressive DAVFs. Same patient as in Fig 3. DSA images before treatment at our institution but 4 years after initial proximal coil embolization of external carotid artery feeders below the skull base at an outside institution demonstrate multiple skull base fistulas associated with venous hypertension, cortical venous reflux, venous sinus dilation, and a jugular bulb outflow stenosis (between white arrows). (Upper row: right vertebral artery lateral, right vertebral artery lateral, left vertebral artery anteroposterior; lower row: left ICA anteroposterior, left external carotid artery anteroposterior, left external carotid artery lateral). A middle meningeal artery to the torcular fistula indicated by the white arrows is shown in greater detail in Fig 5.