dAVF With PVR Portends Higher Malignant Natural History

Background: Cerebral dural arteriovenous fistulas (dAVFs), shunts within the dural leaflet may result in intracranial hemorrhage (ICH) if drainage into the cortical veins and nonhemorrhagic neurological deficits (NHNDs), eg, paresis, dysphagia, cognitive dysfunction, seizures, Parkinsonism, and cerebellar symptoms. Presentation and venous ectasia have also been recognized as features of more aggressive dAVF. Objective: To delineate the prevalence, clinical presentation, and untreated course of dAVFs with parenchymal venous reflux (PVR) from CVD versus those draining into cortical veins that more simply drain directly into a venous sinus. Design: Single-center retrospective study. Methods: Database analysis was conducted of patients with dAVF with direct cortical venous drainage (CVD). Patients presenting with ICH and NHND were classified as aggressive; whereas headache or pulsatile tinnitus were considered nonaggressive. Among type III and IV dAVFs, venous drainage was stratified int more...