Intracranial Dural Arteriovenous Fistulas: Classification, Imaging Findings, and Treatment

Abstract

SUMMARY:Intracranial DAVFs are pathologic dural-based shunts and account for 10%-15% of all intracranial arteriovenous malformations. These malformations derive their arterial supply primarily from meningeal vessels, and the venous drainage is either via dural venous sinuses or through the cortical veins. DAVFs have a reported association with dural sinus thrombosis, venous hypertension, previous craniotomy, and trauma, though many lesions are idiopathic. The diagnosis is dependent on a high level of clinical suspicion and high-resolution imaging. Cross-sectional imaging techniques by using CT and MR imaging aid in the diagnosis, but conventional angiography remains the most accurate method for complete characterization and classification of DAVFs. The pattern of venous drainage observed on dynamic vascular imaging determines the type of DAVF and correlates with the severity of symptoms and the risk of hemorrhage.ABBREVIATIONS: CVD ϭ cortical venous drainage; DAVF ϭ dural arteriovenous fistula; DMSO ϭ dimethyl-sulfoxide; FPCT ϭ flat panel detector CT; n-BCA ϭ n-butyl 2-cyanoacrylate; NHND ϭ non-hemorrhagic neurologic deficit; SRS ϭ stereotactic radiosurgery; TAE ϭ transarterial embolization; TVE ϭ transvenous embolization

Long-Term Endovascular Treatment Outcome of 46 Patients with Cavernous Sinus Dural Arteriovenous Fistulas Presenting with Ophthalmic Symptoms

“…Some alarming ophthalmic symptoms, such as ophthalmic proptosis, extraocular muscle palsies, chemosis, visual loss, and diplopia, as well as intracranial bruits may develop in patients with cDAVF [6][7][8] . The main management approaches for cDAVFs have included observation, stereotactic radiosurgery, intermittent manual compression of the ICA, endovascular treatment (transarterial or transvenous embolization), and neurosurgery 9 . Endovascular techniques are the most commonly used treatment for patients with symptomatic cDAVFs that do not spontaneously resolve.…”

Image Diagnosis: Encephalopathy Resulting from Dural Arteriovenous Fistula

“…[2][3][4] The initiating events which lead to their development are not clear, but the literature reports association with trauma, infection, recent surgery, and dural sinus thrombosis. [2][3][4] A wide variety of signs and symptoms, which can vary because of lesion location and pattern of venous drainage, may arise from DAVFs, namely, pulsatile tinnitus, ophthalmoplegia, proptosis, chemosis, retro-orbital pain, decreased visual acuity, seizures, Parkinsonism, cerebellar symptoms, apathy, and dementia. [2][3][4] …”

“…[2][3][4] A wide variety of signs and symptoms, which can vary because of lesion location and pattern of venous drainage, may arise from DAVFs, namely, pulsatile tinnitus, ophthalmoplegia, proptosis, chemosis, retro-orbital pain, decreased visual acuity, seizures, Parkinsonism, cerebellar symptoms, apathy, and dementia. [2][3][4] …”

Dural Arteriovenous Fistula as a Treatable Dementia

“…Th e presence of a transverse sinus thrombus in our patient corroborates previous reports identifying thrombosis in the venous sinuses as a possible trigger for developing DAVF (3-6). DAVF usually presents in the fi fth or sixth decades of life (3,6). It occurs with a female-to-male ratio of 1:1.65 (1).…”

“…Th ere are only a few reports of DAVFs presenting with dementia syndrome, a decline in neurocognitive function, and parkinsonism (3,7). Th e clinical presentation of DAVFs depends on their location and pattern of cerebral venous drainage (1,3,6). DAVFs with isolated dural sinus drainage have a benign clinical course.…”