Dural arteriovenous fistula
An overview of dural arteriovenous fistula
Dural Arteriovenous Fistula[edit | edit source]
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.
Pathophysiology[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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.
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Contributors: Prab R. Tumpati, MD