Developmental venous anomaly associated with dural arteriovenous fistula: Etiopathogenesis and hemorrhagic risk
IntroductionDevelopmental venous anomalies (DVAs) have traditionally been defined as non-pathological congenital lesions. Compared to isolated DVAs, the association of DVAs with arteriovenous shunts seems to have a more adverse clinical connotation. In this review, we describe the association betwee...
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| Language: | English |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1141857/full |
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| author | Edoardo Agosti Lucio De Maria Pier Paolo Panciani Simona Serioli Dikran Mardighian Marco Maria Fontanella Giuseppe Lanzino |
| author_facet | Edoardo Agosti Lucio De Maria Pier Paolo Panciani Simona Serioli Dikran Mardighian Marco Maria Fontanella Giuseppe Lanzino |
| author_sort | Edoardo Agosti |
| collection | DOAJ |
| description | IntroductionDevelopmental venous anomalies (DVAs) have traditionally been defined as non-pathological congenital lesions. Compared to isolated DVAs, the association of DVAs with arteriovenous shunts seems to have a more adverse clinical connotation. In this review, we describe the association between DVA and dAVF and discuss the hemorrhagic risk. We also advance a hypothesis about the potential de novo formation of a DVA and challenge the dogma about their “developmental” or “congenital” nature.MethodsA systematic review of the literature on the association of DVA and dAVF was performed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines.ResultsA number of 678 papers was initially identified, but only 9 studies were included in the final qualitative analysis. Most of the patients presented with bleeding (56%), with a median GCS of 14 (range 10–15). In 56% of the cases the DVA had a supratentorial location. Supratentorial DVAs mostly drained in the superior sagittal sinus (80%), while all of infratentorial/combined DVAs drained in deep ependymal veins of the 4th ventricle. All the supratentorial dAVFs drained into the superior sagittal sinus, while the infratentorial/combined dAVFs mostly drained in the jugular bulb, Vein of Rosenthal, or transverse-sigmoid sinuses (75%). Most of the dAVFs were classified as Cognard type IIa + b (67%), while in a smaller number of cases type I (22%) and type V (11%). The dAVF was the target of treatment in each case and most patients underwent endovascular treatment (78%). The dAVF was completely occluded in 78% of cases and no periprocedural complications were reported.ConclusionThe clinical presentation, radiological findings, and treatment outcomes of DVAs and associated dAVFs have been discussed. Despite the general opinion that DVAs are benign congenital lesions, increasing epidemiological and radiological evidence supports a potential acquired origin, and the venous system seem to play a pivotal role in their post-natal genesis and development. |
| first_indexed | 2024-04-09T23:29:51Z |
| format | Article |
| id | doaj.art-9043c3c8e4f344f2a35881bea7421345 |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-04-09T23:29:51Z |
| publishDate | 2023-03-01 |
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| series | Frontiers in Surgery |
| spelling | doaj.art-9043c3c8e4f344f2a35881bea74213452023-03-21T06:10:57ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2023-03-011010.3389/fsurg.2023.11418571141857Developmental venous anomaly associated with dural arteriovenous fistula: Etiopathogenesis and hemorrhagic riskEdoardo Agosti0Lucio De Maria1Pier Paolo Panciani2Simona Serioli3Dikran Mardighian4Marco Maria Fontanella5Giuseppe Lanzino6Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, ItalyDivision of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, ItalyDivision of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, ItalyDivision of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, ItalyDivision of Neuroradiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, ItalyDivision of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, ItalyDepartment of Neurologic Surgery, Mayo Clinic, Rochester, MN, United StatesIntroductionDevelopmental venous anomalies (DVAs) have traditionally been defined as non-pathological congenital lesions. Compared to isolated DVAs, the association of DVAs with arteriovenous shunts seems to have a more adverse clinical connotation. In this review, we describe the association between DVA and dAVF and discuss the hemorrhagic risk. We also advance a hypothesis about the potential de novo formation of a DVA and challenge the dogma about their “developmental” or “congenital” nature.MethodsA systematic review of the literature on the association of DVA and dAVF was performed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines.ResultsA number of 678 papers was initially identified, but only 9 studies were included in the final qualitative analysis. Most of the patients presented with bleeding (56%), with a median GCS of 14 (range 10–15). In 56% of the cases the DVA had a supratentorial location. Supratentorial DVAs mostly drained in the superior sagittal sinus (80%), while all of infratentorial/combined DVAs drained in deep ependymal veins of the 4th ventricle. All the supratentorial dAVFs drained into the superior sagittal sinus, while the infratentorial/combined dAVFs mostly drained in the jugular bulb, Vein of Rosenthal, or transverse-sigmoid sinuses (75%). Most of the dAVFs were classified as Cognard type IIa + b (67%), while in a smaller number of cases type I (22%) and type V (11%). The dAVF was the target of treatment in each case and most patients underwent endovascular treatment (78%). The dAVF was completely occluded in 78% of cases and no periprocedural complications were reported.ConclusionThe clinical presentation, radiological findings, and treatment outcomes of DVAs and associated dAVFs have been discussed. Despite the general opinion that DVAs are benign congenital lesions, increasing epidemiological and radiological evidence supports a potential acquired origin, and the venous system seem to play a pivotal role in their post-natal genesis and development.https://www.frontiersin.org/articles/10.3389/fsurg.2023.1141857/fullintracranial vascular malformationdevelopmental venous anomalydural arteriovenous fistulaetiopathogenesis, hemorrhagic risk |
| spellingShingle | Edoardo Agosti Lucio De Maria Pier Paolo Panciani Simona Serioli Dikran Mardighian Marco Maria Fontanella Giuseppe Lanzino Developmental venous anomaly associated with dural arteriovenous fistula: Etiopathogenesis and hemorrhagic risk Frontiers in Surgery intracranial vascular malformation developmental venous anomaly dural arteriovenous fistula etiopathogenesis, hemorrhagic risk |
| title | Developmental venous anomaly associated with dural arteriovenous fistula: Etiopathogenesis and hemorrhagic risk |
| title_full | Developmental venous anomaly associated with dural arteriovenous fistula: Etiopathogenesis and hemorrhagic risk |
| title_fullStr | Developmental venous anomaly associated with dural arteriovenous fistula: Etiopathogenesis and hemorrhagic risk |
| title_full_unstemmed | Developmental venous anomaly associated with dural arteriovenous fistula: Etiopathogenesis and hemorrhagic risk |
| title_short | Developmental venous anomaly associated with dural arteriovenous fistula: Etiopathogenesis and hemorrhagic risk |
| title_sort | developmental venous anomaly associated with dural arteriovenous fistula etiopathogenesis and hemorrhagic risk |
| topic | intracranial vascular malformation developmental venous anomaly dural arteriovenous fistula etiopathogenesis, hemorrhagic risk |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2023.1141857/full |
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