Dural arteriovenous fistula

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
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Dural arteriovenous fistula
Synonyms	DAVF
Pronounce	N/A
Specialty	N/A
Symptoms	Headache, tinnitus, seizures, neurological deficits
Complications	Intracranial hemorrhage, cerebral ischemia
Onset	Typically in adulthood
Duration	Chronic
Types	N/A
Causes	Abnormal connections between dural arteries and dural venous sinuses
Risks	Head trauma, surgery, venous sinus thrombosis
Diagnosis	MRI, CT, Cerebral angiography
Differential diagnosis	Arteriovenous malformation, cavernous sinus fistula, carotid-cavernous fistula
Prevention	N/A
Treatment	Endovascular embolization, surgical resection, stereotactic radiosurgery
Medication	N/A
Prognosis	Variable, depending on location and treatment
Frequency	Rare
Deaths	N/A

An overview of dural arteriovenous fistula

A dural arteriovenous fistula (DAVF) is an abnormal connection between an artery and a vein in the dura mater, the outermost layer of the meninges surrounding the brain and spinal cord. This condition can lead to various neurological symptoms depending on the location and size of the fistula.

Illustration of a dural arteriovenous fistula in the superior sagittal sinus.

Pathophysiology

DAVFs occur when there is an abnormal shunt between the dural arteries and dural venous sinuses or cortical veins. This can result in increased venous pressure, leading to venous hypertension and potential hemorrhage. The exact cause of DAVFs is not well understood, but they may develop following trauma, surgery, or dural sinus thrombosis.

Clinical Presentation

The symptoms of a dural arteriovenous fistula can vary widely. Common symptoms include:

• Headaches
• Pulsatile tinnitus
• Neurological deficits
• Seizures
• Intracranial hemorrhage

The severity of symptoms often correlates with the size and location of the fistula, as well as the degree of venous hypertension.

Diagnosis

The diagnosis of a DAVF is typically made using imaging studies. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) are often used initially. Digital subtraction angiography (DSA) is considered the gold standard for diagnosis, as it provides detailed images of the blood vessels and can help in planning treatment.

Treatment

Treatment options for DAVFs include:

• Endovascular embolization: A minimally invasive procedure where materials are used to block the abnormal blood vessels.
• Surgical resection: In some cases, the fistula may be surgically removed.
• Stereotactic radiosurgery: A non-invasive option that uses focused radiation to close the fistula over time.

The choice of treatment depends on the specific characteristics of the fistula and the patient's overall health.

Prognosis

The prognosis for patients with a dural arteriovenous fistula varies. With appropriate treatment, many patients experience significant improvement in symptoms. However, untreated DAVFs can lead to serious complications, including intracerebral hemorrhage and neurological deficits.

See also

• Arteriovenous malformation
• Cerebral aneurysm
• Intracranial hemorrhage