ĐẶC ĐIỂM LÂM SÀNG VÀ CHẨN ĐOÁN HÌNH ẢNH CỦA RÒ ĐỘNG TĨNH MẠCH MÀNG CỨNG NỘI SỌ TẠI BỆNH VIỆN ĐẠI HỌC Y HÀ NỘI

Abstract

Background: Intracranial dural arteriovenous fistula (DAVF) is an abnormal arteriovenous shunt within the dural leaflets, accounting for approximately 10–15% of intracranial vascular malformations. It typically affects middle‑aged adults, shows a female predominance, and presents with diverse symptoms and potentially complex complications. Digital subtraction angiography (DSA) remains the gold standard for diagnosis and for guiding therapy. Objective: To describe clinical and imaging characteristics and analyze venous drainage patterns of intracranial DAVFs in adult patients at Hanoi Medical University Hospital. Materials and Methods: A retrospective cross‑sectional study was conducted on 76 patients diagnosed with intracranial DAVF by DSA. The Barrow classification (for cavernous sinus fistulas) and the Cognard classification (for fistulas at all locations) were applied. Results: Among the 76 patients enrolled in the study, the female-to-male ratio was 50:26, with a mean age of 56.7 ± 15.9 years. Headache was the most common clinical symptom (63.2%), followed by ocular and otic manifestations such as conjunctival congestion (47.4%), tinnitus (44.7%), and proptosis (43.4%). The fistula locations were as follows: cavernous sinus (77.6%), transverse/sigmoid sinus each 5.3%, superior/inferior tentorial sinus each 1.3%, and multiple fistula sites in 9.2% of cases, suggesting complex lesions with challenging endovascular management. According to Barrow’s classification, direct fistulas accounted for 25.4%, while indirect types (B–D) represented 74.6%. Based on Cognard’s classification, most lesions were grades I–IIa (80.3%), whereas grades III–IV–V accounted for 3.9%. There was a strong correlation between clinical presentation and cavernous sinus involvement, as well as between direct cavernous sinus fistulas and a history of trauma. The incidence of inferior petrosal sinus occlusion among patients with cavernous sinus fistulas was 11.9%. Conclusions: Intracranial dural arteriovenous fistulas (DAVFs) predominantly occur in middle-aged individuals, with a higher prevalence in females. The cavernous sinus is the most common site, often presenting with prominent orbital and auricular symptoms. Trauma is the leading cause of direct cavernous sinus fistulas. Evaluation of the venous drainage pathways, particularly the patency of the inferior petrosal sinus, plays a crucial role in planning endovascular intervention strategies.