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An Occlusion and Stenosis of the Venous Drainage System in Cerebral AVMs : Angiographical Investigation Noriaki Tomura 1 , Kenji Hirata 1 , Jiro Watarai 1 , Toshio Kato 1 , Tetsuya Sakamoto 2 , Katsuyoshi Mineura 3 , Masayoshi Kowada 3 1Department of Radiology, Akita University School of Medicine 2Department of Neurosurgery, Akita Kumiai General Hospital 3Department of Neurosurgical Service, Akita University School of Medicine Keyword: arteriovenous malformation , angiography , venous occlusion , draining vein pp.531-536
Published Date 1993/6/1
DOI https://doi.org/10.11477/mf.1406900493
  • Abstract
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We investigated angiographically occlusion or stenosis of draining veins in cases of arteriovenous malformations (AVMs). The subjects were 51 cases who were diagnosed as cerebral AVMs by angiography in our hospital between April 1973 and January 1991. Those consisted of 8 dural AVMs, 3 mixed pial-dural AVMs, and 40 pial AVMs. Angio-graphy was steroscopically done in all cases. Angio-grams obtained prior to treatment were retrospec-tively analyzed. Cases of dural AVMs or arterio-venous fistulae in the cavernous sinus were excluded from the subjects. Eight of 51 cases (16%) had occlusion or stenosis of draining veins ; i. e., 2 dural AVMs, 1 mixed pial-dural AVM, 5 pial AVMs. One of 2 dural AVMs was located in the sigmoid sinus, and another involved the superior sagittal sinus. One mixed pial-dural AVM was a vein of Galen aneurysm. Occlusion or stenosis was recognized at the junction of the vein of Galen to the straight sinus (3 cases), in the straight sinus (2 cases), at thejunction of the vein of Labbe to the transverse sinus (1 case), in the superior sagittal sinus (1 case), and in the sigmoid sinus (1 case). Two of 8 cases with occlusion or stenosis of draining vein presented with hemorrhage at the site of AVMs. In cases of pial AVMs, occlusion or stenosis of draining vein seemed be related to endothelial changes due to turbulent and irregular flow. On the other hand, in cases of dural AVM with dural sinus occlusion, sinus abnormalities may precede the formation of fistulous communications. In 5 of total 8 cases (63%), many engorged cortical and medullary veins due to a reflux from the site of occlusion or stenosis were seen. This suggested that those cases had a high risk of hemorrhage at sites far from AVMs as well as near the AVMs. Moreover, they seemed to have a high risk of dementia which was caused by diminished cerebral blood flow due to an increased venous pressure.


Copyright © 1993, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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