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Intracranial Dural Arteriovenous Fistula

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Neurointervention in the Medical Specialties

Part of the book series: Current Clinical Neurology ((CCNEU))

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Abstract

Intracranial dural arteriovenous fistulae (dAVFs) are vascular lesions resulting from an abnormal anastomotic connection between meningeal arteries and a dural venous sinus or cortical vein. Their natural history ranges from benign to potentially fatal if they result in intracranial hemorrhage. Diagnosis is made primarily by imaging, including noninvasive techniques, but cerebral angiography remains the gold standard. In this chapter, we review the presentation characteristics, imaging findings, predictors of associated intracranial hemorrhage, and treatment strategies for dAVFs.

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References

  1. Rizzoli F. Di un aneurisma arterioso-venoso attraversante la parete del cranio : costituito da un grosso ramo dell’arteria occipitale sinistra e dal seno trasverso destro della dura madre, non che di un altro aneurisma, e di ferite pure dell’arteria occipitale : mem [Internet]. Bologna; 1873. Available from: https://wellcomecollection.org/works/hgq3z9dn.

  2. Gomez J, Amin AG, Gregg L, Gailloud P. Classification schemes of cranial dural arteriovenous fistulas. Neurosurg Clin N Am [Internet]. 2012;23:55–62. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1042368011000994.

    Article  Google Scholar 

  3. Castaigne P. [René Djindjian, 1918–1977]. Rev Neurol (Paris) [Internet]. 1977;133:736–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/351770.

  4. Newton TH, Cronqvist S. Involvement of dural arteries in intracranial arteriovenous malformations. Radiology [Internet]. 1969;93:1071–8. Available from: http://pubs.rsna.org/doi/10.1148/93.5.1071.

    Article  CAS  Google Scholar 

  5. Elhammady MS, Ambekar S, Heros RC. Chapter 9 – Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas. In: Spetzler RF, Moon K, Almefty RO, editors. Arter cavernous malformations [Internet]. Elsevier; 2017. p. 99–105. Available from: http://www.sciencedirect.com/science/article/pii/B9780444636409000096.

    Chapter  Google Scholar 

  6. van Dijk JMC, TerBrugge KG, Willinsky RA, Wallace MC. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke [Internet]. 2002;33:1233–6. Available from: https://www.ahajournals.org/doi/10.1161/01.STR.0000014772.02908.44.

    Article  Google Scholar 

  7. LaHue SC, Kim H, Pawlikowska L, Nelson J, Cooke DL, Hetts SW, et al. Frequency and characteristics associated with inherited thrombophilia in patients with intracranial dural arteriovenous fistula. J Neurosurg [Internet]. American Association of Neurological Surgeons. 2019;130:1346–50. Available from: https://thejns.org/view/journals/j-neurosurg/aop/article-10.3171-2017.10.JNS171987.xml.

    Google Scholar 

  8. Chaudhary MY, Sachdev VP, Cho SH, Weitzner I, Puljic S, Huang YP. Dural arteriovenous malformation of the major venous sinuses: an acquired lesion. AJNR Am J Neuroradiol [Internet]. 1982;3:13–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/6800236.

  9. Reynolds MR, Lanzino G, Zipfel GJ. Intracranial dural arteriovenous fistulae. Stroke [Internet]. 2017;48:1424–31. Available from: https://www.ahajournals.org/doi/10.1161/STROKEAHA.116.012784.

    Article  Google Scholar 

  10. Chaichana KL, Coon AL, Tamargo RJ, Huang J. Dural arteriovenous fistulas: epidemiology and clinical presentation. Neurosurg Clin N Am [Internet]. 2012;23:7–13. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1042368011000970.

    Article  Google Scholar 

  11. Miller TR, Gandhi D. Intracranial dural Arteriovenous Fistulae. Stroke [Internet]. 2015;46:2017–25. Available from: http://stroke.ahajournals.org/lookup/doi/10.1161/STROKEAHA.115.008228.

    Article  Google Scholar 

  12. Kim MS, Han DH, Kwon O-K, Oh C-W, Han MH. Clinical characteristics of dural arteriovenous fistula. J Clin Neurosci [Internet]. 2002;9:147–55. Available from: https://linkinghub.elsevier.com/retrieve/pii/S096758680191029X.

    Article  Google Scholar 

  13. Chung SJ, Kim JS, Kim JC, Lee SK, Kwon SU, Lee MC, et al. Intracranial dural arteriovenous fistulas: analysis of 60 patients. Cerebrovasc Dis [Internet]. 2002;13:79–88. Available from: https://www.karger.com/Article/FullText/47755.

    Article  Google Scholar 

  14. Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology [Internet]. 1995;194:671–80. Available from: http://pubs.rsna.org/doi/10.1148/radiology.194.3.7862961.

  15. Brown RD, Wiebers DO, Nichols DA. Intracranial dural arteriovenous fistulae: angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients. J Neurosurg [Internet]. 1994;81:531–8. Available from: https://thejns.org/view/journals/j-neurosurg/81/4/article-p531.xml.

    Article  Google Scholar 

  16. Davies MA, TerBrugge K, Willinsky R, Coyne T, Saleh J, Wallace MC. The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg [Internet]. 1996;85:830–7. Available from: https://thejns.org/view/journals/j-neurosurg/85/5/article-p830.xml.

    Article  CAS  Google Scholar 

  17. Motebejane MS, Choi IS. Foramen magnum dural arteriovenous fistulas: clinical presentations and treatment outcomes, a case-series of 12 patients. Oper Neurosurg [Internet]. 2018;15:262–9. Available from: https://academic.oup.com/ons/article/15/3/262/4605233.

    Article  Google Scholar 

  18. Santillan A, Nanaszko M, Burkhardt J-K, Patsalides A, Gobin YP, Riina HA. Endovascular management of intracranial dural arteriovenous fistulas: a review. Clin Neurol Neurosurg [Internet]. 2013;115:241–51. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0303846712005999.

    Article  Google Scholar 

  19. Reinges MHT, Thron A, Mull M, Huffmann BC, Gilsbach JM. Dural arteriovenous fistulae at the foramen magnum. J Neurol [Internet]. 2001;248:197–203. Available from: http://link.springer.com/10.1007/s004150170226.

    Article  CAS  Google Scholar 

  20. Corbelli I, De Maria F, Eusebi P, Romoli M, Cardaioli G, Hamam M, et al. Dural arteriovenous fistulas and headache features: an observational study. J Headache Pain [Internet]. 2020;21:6. Available from: https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-020-1073-1.

  21. Naserrudin NS, Mohammad Raffiq MA. Dural arteriovenous fistula mimicking temporal arteritis. Clin Neurol Neurosurg [Internet]. 2019;176:44–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0303846718304529.

    Article  Google Scholar 

  22. Nomura M, Mori K, Tamase A, Kamide T, Seki S, Iida Y, et al. Cavernous sinus dural arteriovenous fistula patients presenting with headache as an initial symptom. J Clin Med Res [Internet]. 2016;8:342–5. Available from: http://www.jocmr.org/index.php/JOCMR/article/view/2489.

  23. Saad AF, Chaudhari R, Fischbein NJ, Wintermark M. Intracranial hemorrhage imaging. Semin Ultrasound, CT MRI [Internet]. 2018;39:441–56. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0887217118300052.

  24. Kranz PG, Malinzak MD, Amrhein TJ. Approach to imaging in patients with spontaneous intracranial hemorrhage. Neuroimaging Clin N Am [Internet]. 2018;28:353–74. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1052514918300285.

    Article  Google Scholar 

  25. Daniels DJ, Vellimana AK, Zipfel GJ, Lanzino G. Intracranial hemorrhage from dural arteriovenous fistulas: clinical features and outcome. Neurosurg Focus [Internet]. 2013;34:E15. Available from: https://thejns.org/view/journals/neurosurg-focus/34/5/article-pE15.xml.

  26. Pegge SAH, Steens SCA, Kunst HPM, Meijer FJA. Pulsatile tinnitus: differential diagnosis and radiological work-up. Curr Radiol Rep [Internet]. 2017;5:5. Available from: http://link.springer.com/10.1007/s40134-017-0199-7.

  27. Kuybu O, Dossani RH. Cavernous sinus syndromes [Internet]. StatPearls Publishing, Treasure Island (FL); 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532976/.

  28. Keane JR. Cavernous sinus syndrome. Analysis of 151 cases. Arch Neurol [Internet]. 1996;53:967–71. Available from: http://archneur.jamanetwork.com/article.aspx?doi=10.1001/archneur.1996.00550100033012.

  29. Beijer TR, van Dijk EJ, de Vries J, Vermeer SE, Prokop M, Meijer FJA. 4D-CT angiography differentiating arteriovenous fistula subtypes. Clin Neurol Neurosurg [Internet]. 2013;115:1313–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0303846712006257.

    Article  Google Scholar 

  30. Biswas S, Chandran A, Radon M, Puthuran M, Bhojak M, Nahser HC, et al. Accuracy of four-dimensional CT angiography in detection and characterisation of arteriovenous malformations and dural arteriovenous fistulas. Neuroradiol J [Internet]. 2015;28:376–84. Available from: http://journals.sagepub.com/doi/10.1177/1971400915604526.

    Article  Google Scholar 

  31. In ’t Veld M, Fronczek R, dos Santos MP, van Walderveen MAA, Meijer FJA, Willems PWA. High sensitivity and specificity of 4D-CTA in the detection of cranial arteriovenous shunts. Eur Radiol [Internet]. 2019;29:5961–70. Available from: http://link.springer.com/10.1007/s00330-019-06234-4.

  32. Willems PWA, Brouwer PA, Barfett JJ, TerBrugge KG, Krings T. Detection and classification of cranial dural arteriovenous fistulas using 4D-CT angiography: initial experience. Am J Neuroradiol [Internet]. 2011;32:49–53. Available from: http://www.ajnr.org/lookup/doi/10.3174/ajnr.A2248.

    Article  CAS  Google Scholar 

  33. Nishimura S, Hirai T, Sasao A, Kitajima M, Morioka M, Kai Y, et al. Evaluation of dural arteriovenous fistulas with 4D contrast-enhanced MR angiography at 3T. Am J Neuroradiol [Internet]. 2010;31:80–5. Available from: http://www.ajnr.org/lookup/doi/10.3174/ajnr.A1898.

  34. Farb RI, Agid R, Willinsky RA, Johnstone DM, TerBrugge KG. Cranial dural arteriovenous fistula: diagnosis and classification with time-resolved MR Angiography at 3T. Am J Neuroradiol [Internet]. 2009;30:1546–51. Available from: http://www.ajnr.org/lookup/doi/10.3174/ajnr.A1646.

  35. Grossberg JA, Howard BM, Saindane AM. The use of contrast-enhanced, time-resolved magnetic resonance angiography in cerebrovascular pathology. Neurosurg Focus [Internet]. 2019;47:E3. Available from: https://thejns.org/view/journals/neurosurg-focus/47/6/article-pE3.xml.

  36. Jang J, Schmitt P, Kim B, Choi HS, Jung S-L, Ahn K-J, et al. Non-contrast-enhanced 4D MR angiography with STAR spin labeling and variable flip angle sampling: a feasibility study for the assessment of Dural Arteriovenous Fistula. Neuroradiology [Internet]. 2014;56:305–14. Available from: http://link.springer.com/10.1007/s00234-014-1336-0.

  37. Iryo Y, Hirai T, Kai Y, Nakamura M, Shigematsu Y, Kitajima M, et al. Intracranial Dural arteriovenous fistulas: evaluation with 3-T four-dimensional MR angiography using arterial spin labeling. Radiology [Internet]. 2014;271:193–9. Available from: http://pubs.rsna.org/doi/10.1148/radiol.13122670.

    Article  Google Scholar 

  38. Suzuki Y, Fujima N, van Osch MJP. Intracranial 3D and 4D MR angiography using arterial spin labeling: technical considerations. Magn Reson Med Sci [Internet]. 2020;19:294–309. Available from: https://www.jstage.jst.go.jp/article/mrms/19/4/19_rev.2019-0096/_article.

  39. Benndorf G. Classification of Cavernous Sinus Fistulas (CSFs) and Dural Arteriovenous Fistulas (DAVFs). Dural Cavernous Sinus Fistulas Diagnostic Endovasc Ther [Internet]. Berlin, Heidelberg: Springer Berlin Heidelberg; 2010. p. 51–63. Available from: https://doi.org/10.1007/978-3-540-68889-1_4.

  40. Satomi J, van Dijk JMC, Terbrugge KG, Willinsky RA, Wallace MC. Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion. J Neurosurg [Internet]. Journal of Neurosurgery Publishing Group. 2002;97:767–70. Available from: https://thejns.org/view/journals/j-neurosurg/97/4/article-p767.xml.

    Google Scholar 

  41. Davies MA, Saleh J, ter Brugge K, Willinsky R, Wallace MC. The natural history and management of intracranial dural arteriovenous fistulae. Interv Neuroradiol [Internet]. 1997;3:295–302. Available from: http://journals.sagepub.com/doi/10.1177/159101999700300404.

    Article  CAS  Google Scholar 

  42. Baharvahdat H, Ooi YC, Kim WJ, Mowla A, Coon AL, Colby GP. Updates in the management of cranial dural arteriovenous fistula. Stroke Vasc Neurol [Internet]. 2020;5:50–8. Available from: https://svn.bmj.com/lookup/doi/10.1136/svn-2019-000269.

    Article  Google Scholar 

  43. Gross BA, Albuquerque FC, Moon K, McDougall CG. Evolution of treatment and a detailed analysis of occlusion, recurrence, and clinical outcomes in an endovascular library of 260 dural arteriovenous fistulas. J Neurosurg [Internet]. American Association of Neurological Surgeons. 2016;126:1884–93. Available from: https://thejns.org/view/journals/j-neurosurg/126/6/article-p1884.xml.

    Google Scholar 

  44. Nelson PK, Russell SM, Woo HH, Alastra AJG, Vidovich D V. Use of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients. J Neurosurg [Internet]. 2003;98:498–506. Available from: https://thejns.org/view/journals/j-neurosurg/98/3/article-p498.xml.

  45. Spiotta AM, Miranpuri AS, Vargas J, Magarick J, Turner RD, Turk AS, et al. Balloon augmented Onyx embolization utilizing a dual lumen balloon catheter: utility in the treatment of a variety of head and neck lesions. J Neurointerv Surg [Internet]. 2014;6:547–55. Available from: http://jnis.bmj.com/lookup/doi/10.1136/neurintsurg-2013-010833.

  46. Piechowiak E, Zibold F, Dobrocky T, Mosimann PJ, Bervini D, Raabe A, et al. Endovascular treatment of dural arteriovenous fistulas of the transverse and sigmoid sinuses using transarterial balloon-assisted embolization combined with transvenous balloon protection of the venous sinus. Am J Neuroradiol [Internet]. 2017;38:1984–9. Available from: http://www.ajnr.org/lookup/doi/10.3174/ajnr.A5333.

  47. Dabus G, Kan P, Diaz C, Pabon B, Andres-Mejia J, Linfante I, et al. Endovascular treatment of anterior cranial fossa dural arteriovenous fistula: a multicenter series. Neuroradiology [Internet]. 2020.; Available from: http://link.springer.com/10.1007/s00234-020-02536-3.

  48. Ghobrial GM, Marchan E, Nair AK, Dumont AS, Tjoumakaris SI, Gonzalez LF, et al. Dural arteriovenous Fistulas: a review of the literature and a presentation of a single Institution’s experience. World Neurosurg [Internet]. 2013;80:94–102. Available from: http://www.sciencedirect.com/science/article/pii/S187887501200126X.

    Article  Google Scholar 

  49. Yang H, Kano H, Kondziolka D, Niranjan A, Flickinger JC, Horowitz MB, et al. Stereotactic radiosurgery with or without embolization for intracranial dural arteriovenous fistulas. Neurosurgery [Internet]. 2010;67:1276–85. Available from: https://academic.oup.com/neurosurgery/article/67/5/1276/2563881.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, UTHealth McGovern Medical School, Houston, TX, USA

    Hyeyoung Seol, Mohammad A. Abdulrazzak, Jonathan Greco & Sunil A. Sheth

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Correspondence to Sunil A. Sheth .

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  1. Neurology and Psychiatry, Saint Louis University, Saint Louis, MO, USA

    Randall C. Edgell

  2. Department of Neurology, Saint Louis University, St. Louis, MO, USA

    Kara M. Christopher

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Seol, H., Abdulrazzak, M.A., Greco, J., Sheth, S.A. (2022). Intracranial Dural Arteriovenous Fistula. In: Edgell, R.C., M. Christopher, K. (eds) Neurointervention in the Medical Specialties. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-030-87428-5_13

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