September 10, 2015: Dural arteriovenous fistulas
September 10, 2015
Dural arteriovenous fistulas
Intracranial dural arteriovenous fistulas (DAVF) account for 10-15 percent of intracranial malformations, and most are in the transverse-sigmoid or cavernous sinuses. The main feeding arteries for DAVFs are typically branches of the external carotid artery; however, due to differential risk of rupture based on the location of venous drainage, classification systems are derived primarily from patterns of venous drainage. While some DAVFs are congenital, the majority are acquired and risk factors include prior venous sinus thrombosis, head trauma, neurosurgical procedures, and being in the postpartum period.
Dural arteriovenous fistulas can be asymptomatic or can exhibit signs such as pulsitile tinnitus, raised intracranial pressure with subsequent headaches and papilledema, cranial nerve deficits, exopthalmus, and cardiac damage causing congestive heart failure. The treatment decision is based on the location and individual characteristics of the DAVF, such as chance of spontaneous regression, risk of bleed, and persistence of neurological symptoms and signs. Options for treatment include embolization via open craniotomy, radiosurgery, or endovascular techniques.
- Cognard C, Gobin YP, Pierot L et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995; 194: 671-680.
- Luo CB, Chang FC, Teng MM. Update of embolization of intracranial dural arteriovenous fistula. Journal of the Chinese Medical Association 2014; 77: 610-617.
Submitted by Sarah Wesley MD, Department of Neurology, Mount Sinai Beth Israel Medical Center.
Disclosures: Dr. Wesley is a member of the Residents & Fellows Section of Neurology