Skip to main content
Log in

A proposed angiographic classification of intracranial arteriovenous fistulae and malformations

  • Interventional Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

We propose an angioarchitectural classification of intracranial vascular lesions as arteriovenous, arteriolovenous and arteriolovenulous fistulae. In order to validate this classification, 99 intracranial arteriovenous lesions were reviewed in 98 patients. Arteriolovenulous fistulae included 39 isolated brain arteriovenous malformations (AVMs) and 1 AVM associated with a giant arteriovenous fistula (AVF). Arteriovenous fistulae included 8 giant AVFs of the brain, 6 vein of Galen aneurysms and 10 direct caroticocavernous fistulae. Arteriolovenous fistulae included 1 isolated brain AVM, 4 vein of Galen aneurysms and 30 dural AVMs. The angioarchitectural classification has three advantages. It is simple and accurate, with no reference to the congenital or acquired nature of the lesion. It allows separate identification of a special group, the arteriolovenous fistulae. It also indicates the endovascular approach: arteriolovenulous fistulae should be treated via the arterial route only, while arteriovenous and arteriolovenous fistulae can be treated via transarterial or transvenous approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Forster D, Steiner L, Hakanson S (1972) Arteriovenous malformations of the brain. A long-term clinical study. J Neurosurg 37: 562–570

    Google Scholar 

  2. Crawford P, West C, Chadwick D, Shaw MDM (1986) Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 49: 1–10

    Google Scholar 

  3. Chaudhary M, Sachved V, Cho SH, Weitzner I, Puljic S, Huang YP (1982) Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. AJNR 3: 3–19

    Google Scholar 

  4. Viñuela F, Drake C, Fox A, Pelz DM (1987) Giant intracranial varices secondary to high-flow arteriovenous fistulae. J Neurosurg 66: 198–203

    Google Scholar 

  5. Johnston I, Whittle I, Besser M, Organ M (1987) Vein of Galen malformations: diagnosis and management. Neurosurgery 20: 747–758

    Google Scholar 

  6. Debrun G, Viñuela F, Fox A, Davis K, Ahn HS (1988) Indications for treatment and classification of 132 carotid-cavernous fistulas. Neurosurgery 22: 285–289

    Google Scholar 

  7. Newton T, Troost B, Moseley I (1984) Angiography of arteriovenous malformations and fistulas. In: Wilson C, Stein B (eds) Intracranial arteriovenous malformations. Williams & Wilkins, Baltimore, pp 64–104

    Google Scholar 

  8. Viñuela F (1986) Identification of an arteriovenous fistula in arteriovenous malformations. AJNR 7: 553

    Google Scholar 

  9. Yasargil M (1988) AVM of vein of Galen region. In: Yasargil M (ed) Microneurosurgery vol IIIB. Thieme, Stuttgart pp 323–357

    Google Scholar 

  10. Djindjian R, Merland JJ (1978) Superselective arteriography of the external carotid artery. Springer, Berlin Heidelberg New York

    Google Scholar 

  11. Fermand M, Reizine D, Riché M, Merland J (1987) Long term follow-up of 43 pure dural arteriovenous fistulae of the lateral sinus. Neuroradiology 29: 348–353

    Google Scholar 

  12. Halbach V, Higashida R, Hieshima G, Rosenblum M, Cahan L (1988) Treatment of dural arteriovenous malformations involving the superior sagittal sinus. AJNR 9: 337–343

    Google Scholar 

  13. Stein B (1984) General techniques for the surgical removal of arteriovenous malformations. In: Mulliken, Young (eds) Intracranial arteriovenous malformations. Williams & Wilkins, Baltimore, pp 143–155

    Google Scholar 

  14. Yasargil M (1987) Pathological considerations. In: Yasargil M (ed) Microneurosurgery vol IIIA. Thieme, Stuttgart, pp 49–57

    Google Scholar 

  15. Viñuela F, Debrun G, Fox A, Girvin JP, Peerless SJ (1983) Dominant-hemisphere arteriovenous malformations: therapeutic embolization with isobutyl-2-cyanoacrylate. AJNR 4: 959–966

    Google Scholar 

  16. Casasco A, Lylyk P, Hodes JE, Kohan G, Aymard A, Merland JJ (1991) Percutaneous transvenous catheterization and embolization of vein of Galen aneurysms. Neurosurgery 28: 260–266

    Google Scholar 

  17. Dowd CF, Halbach V, Barnwell S, Higashida RT, Hieshima GB (1990) Transfemoral venous embolization of vein of Galen malformations. AJNR 11: 643–648

    Google Scholar 

  18. Halbach V, Higashida R, Hieshima GB, Hardin CW, Pribram H (1989) Transvenous embolization of dural fistulas involving the cavernous sinus. AJNR 10: 377–383

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Houdart, E., Gobin, Y.P., Casasco, A. et al. A proposed angiographic classification of intracranial arteriovenous fistulae and malformations. Neuroradiology 35, 381–385 (1993). https://doi.org/10.1007/BF00588376

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00588376

Key words

Navigation