Cavernous sinus dural arteriovenous malformations: Patterns of venous drainage are related to clinical signs and symptoms

doi:10.1016/S0161-6420(02)01166-1

Ophthalmology

Volume 109, Issue 9, September 2002, Pages 1685-1691

https://doi.org/10.1016/S0161-6420(02)01166-1 Get rights and content

Abstract

Objective

To provide evidence that venous congestion and drainage patterns are responsible for the manifestations of cavernous sinus area dural arteriovenous malformations (CSdAVMs).

Design

Retrospective observational case series.

Participants

Records of 85 patients with complete clinical and angiographic evaluations of CSdAVMs were evaluated for the clinical features of the disorder. A neuroradiologist analyzed patterns of venous drainage to and from the cavernous sinus without knowledge of the clinical features. Four venous drainage patterns (reversal of flow from the CSdAVMs into the anterior cavernous sinus, ophthalmic vein thrombosis, drainage into the inferior petrosal sinus or drainage into the superior petrosal sinus) were statistically tested for their predictive value of signs and symptoms using logistic regression.

Main outcome measures

The power of prediction of orbital congestion, elevated IOP, extraocular muscle dysfunction, optic neuropathy, venous-stasis retinopathy, choroidal effusion, anterior chamber shallowing, bruits, cranial nerve paresis, and central nervous system dysfunction from four patterns of venous drainage.

Results

Reversal of drainage into the anterior cavernous sinus and ophthalmic veins was highly predictive (P = 0) of orbital congestion, which was seen in 77 (91%) patients. In contrast, eight (9%) patients without orbital congestion had shunts that did not drain into the anterior cavernous sinus and ophthalmic veins. Cavernous sinus dural arteriovenous malformation drainage into the anterior cavernous sinus and ophthalmic veins also predicted elevated IOP (P = 0.0023) and optic neuropathy (P = 0.047). Ophthalmic vein thrombosis significantly predicted cases with choroidal effusion (P = 0.002) and anterior chamber shallowing (P = 0.01). Third nerve paresis could be predicted from flow toward the inferior petrosal sinuses (P = 0.017). Central nervous system symptoms or dysfunction, occurring in 7 (8%) patients, was predicted by venous drainage into the superior petrosal sinus (P = 0.0008).

Conclusions

The clinical features found in patients with CSdVAMs are related to the abnormal venous drainage and can be predicted by these venous drainage patterns. Venous congestion and hypertension seem to cause the clinical dysfunction in this disorder.

Section snippets

Materials and methods

The records of 139 patients with CSdAVMs between January 1981 and July 1998 were reviewed and evaluated by MJK at the neuro-ophthalmology services at the Institute of Neurology and Neurosurgery, Beth Israel Medical Center, the New York Eye and Ear Infirmary, and the New York University School of Medicine. Selected from this group were 85 patients with dural arteriovenous malformations (dAVMs) of the cavernous sinus region for whom complete clinical and angiographic evaluations were available.

Results

Of the 85 patients, there were 34 men and 51 women. Average age at presentation was 65.5 years in women and 60.7 years in men. Thirteen patients had true bilateral AV shunts, and 72 patients had unilateral AV shunts.

No patient had filling of the AV shunt via the ophthalmic artery before the appearance of dye in the distal orbital arteries and choroidal blush, and therefore, there were no cases of arterial steal into the AV shunt. Selective ICA angiography showed normal filling of the

Discussion

The predominant pattern of abnormal venous drainage in CSdAVMs, reversal of ophthalmic venous flow, and resultant ophthalmic venous hypertension can predict the presence of orbital congestion, secondary glaucoma, and optic neuropathy (see Results for specific P values). When there are no clinical signs of ophthalmic venous hypertension, such as with the “white-eyed” shunt syndrome, the abnormal venous drainage pattern is predominant in the inferior or superior petrosal sinuses, whereas the

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Cavernous sinus dural arteriovenous malformations: Patterns of venous drainage are related to clinical signs and symptoms

Abstract

Objective

Design

Participants

Main outcome measures

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

Ophthalmology

Ophthalmology

Unusual clinical manifestation of dural arteriovenous malformation

J Neurosurg

Amaurosis fugax as the presenting manifestation of dural arteriovenous malformation

Stroke

Amaurosis fugax caused by dural arteriovenous fistula from the ophthalmic artery

AJNR Am J Neuroradiol