Dural arteriovenous fistulas involving the superior sagittal sinus: acute presentation with intracranial hemorrhage.

BACKGROUND

Intracranial dural arteriovenous fistulas (DAVF) usually drain directly into large dural venous sinuses. Intracranial hemorrhage is therefore unusual with these lesions. Certain subgroups of DAVF may drain into cortical veins causing engorgement, venous hypertension, and hemorrhage. The region of the superior sagittal sinus (SSS), while an unusual location for DAVF, is one in which drainage typically occurs directly into cortical veins.

METHODS

We report on three patients with dural arteriovenous malformations of the superior sagittal sinus, all of whom presented with intracranial hemorrhage. Intraparenchymal hemorrhage in two of the cases was surrounded by excessive edema, suggesting the presence of underlying venous hypertension.

RESULTS

Interventional treatment of all three of the lesions was accomplished at the time of diagnostic angiography.

CONCLUSIONS

SSS DAVF is an uncommon lesion whose presentation is usually with intracranial hemorrhage. Large amounts of edema surrounding an acute hemorrhage may suggest the diagnosis, which usually requires confirmation with angiography. Treatment of SSS DAVF can often be accomplished at the time of diagnostic angiography by embolization using interventional neuroradiologic techniques. When endovascular obliteration of the fistula is not feasible or is incomplete, surgical resection of the DAVF site may be achieved without difficulty.