Dural AV Fistula Treatment
Overview
A dural arteriovenous fistula, often abbreviated dAVF, is an abnormal connection between arteries and veins in the dura, the covering around the brain. Unlike a classic brain AVM, a dAVF typically represents abnormal shunting into a dural venous sinus or cortical vein rather than a compact tangle within brain tissue itself.
Dural fistulas vary from relatively low-risk lesions to dangerous high-grade lesions with cortical venous reflux and elevated risk of neurologic injury or hemorrhage. The natural history depends heavily on venous drainage pattern.
Common symptoms
Symptoms may include:
- Pulsatile tinnitus, or hearing a heartbeat-like sound in one ear or both ears.
- Eye symptoms if the lesion affects venous drainage near the cavernous sinus.
- Neurologic deficits.
- Intracranial hemorrhage in more aggressive lesions.
Why venous drainage matters
Low-grade fistulas without retrograde cortical venous drainage may sometimes be managed more conservatively, while higher-grade fistulas generally require treatment.
How dAVFs are diagnosed
Initial evaluation may include CTA, MRA, or MRI, but diagnostic cerebral angiography is often essential because it defines the feeding arteries, venous outflow pattern, fistula location, and treatment options in detail.
Treatment
- Endovascular embolization
- Through a catheter-based, minimally invasive approach, embolic material or coils may be used to close the abnormal connection, either from the arterial side, the venous side, or both depending on the anatomy.
- In some sinus-based fistulas, the venous pouch or involved sinus is packed with coils to disconnect the lesion. In others, liquid embolic agents are used to penetrate and close the fistulous network.
- Surgery
- Radiosurgery