Factors associated with brainstem congestive encephalopathy in dural arterio-venous fistulas.

Objectives: Cranial dural arterio-venous fistulas (DAVFs) are unique neuro-vascular entities that represent 10-15% of all intra-cranial arterio-venous lesions. This study describes the clinical characteristics and neuro-imaging findings of patients with posterior fossa DAVFs.

Methods: Twenty adult patients with posterior fossa DAVFs were enrolled in this 5-year retrospective study. The clinical details of seven patients with venous congestive encephalopathy are described, and patients with and those without brainstem encephalopathy were compared.

Results: Seven of 20 patients (35%) had brainstem venous congestive encephalopathy complicating the posterior fossa DAVFs. Patients with aggressive clinical symptomatology, aggressive Borden or Cognard classifications, and anterior venous draining patterns had higher risks of brainstem venous congestive encephalopathy. In terms of Glasgow outcome scale, one patient had moderate disabilities, five had severe disabilities, and one expired.

Conclusions: Although most patients had good Glasgow coma scores with varying degrees of clinical symptoms on admission, those with brainstem venous congestive encephalopathy had poor outcomes despite full resolution of the cortical vein reflux.