Neurosurgical Review

, Volume 42, Issue 2, pp 277–285 | Cite as

Arterial aneurysms associated with intracranial dural arteriovenous fistulas: epidemiology, natural history, and management. A systematic review

  • Federico CagnazzoEmail author
  • Andrea Peluso
  • Riccardo Vannozzi
  • Waleed Brinjikji
  • Giuseppe Lanzino
  • Paolo Perrini


Arterial aneurysms are uncommon among patients with dural arteriovenous fistulae (DAVFs), and there is limited information available to guide treatment decisions in such cases. We performed a systematic review of the literature, including a case of a DAVF associated with a flow-related intraorbital ophthalmic artery (OA) aneurysm that we have recently managed. The purpose of our study was to clarify epidemiology, natural history, and management of these lesions. A total of 43 published cases of DAVF associated aneurysms were found in 26 studies on the topic. Anterior cranial fossa was the most common location (40%), and ethmoidal branches were the most common arterial feeders (55%). In about 63% of cases, the aneurysm was located on artery unrelated to DAVF supply. Approximately 10% of intracranial DAVFs were associated with aneurysms located in the intraorbital OA. Overall, 70% of lesions were Borden type III, and 50% of patients presented with hemorrhage. In approximately 17% of cases, the source of bleeding was a feeding artery aneurysm. All of the reported intraorbital OA aneurysms associated with DAVFs remained stable during follow-up. DAVF associated aneurysms are fairly rare. Anterior cranial fossa location and direct cortical venous drainage are common among these lesions. The aneurysms are less likely to be located on feeding arteries, and hemorrhagic presentation related to flow-related aneurysm rupture is uncommon.


Intracranial aneurysms Dural arteriovenous fistula Aneurysm rupture Intraorbital aneurysm 


Compliance with ethical standards

This work was performed ethically and complies with the ethical standards of our Institutional Review Board.

Conflict of interest

Dr.Cagnazzo, Dr. Peluso, Dr. Vannozzi, Dr. Brinjikji, and Dr. Perrini certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Dr. Lanzino reports being a consultant for Covidien/Medtronic.

Informed consent

The nature of this article did not require informed consent.

Supplementary material

10143_2017_929_Fig4_ESM.gif (18 kb)
Supplemental Figure 1

PRISMA diagram detailing the specifics of the systematic literature review. (GIF 17 kb).

10143_2017_929_MOESM1_ESM.tif (2 mb)
High Resolution Image (TIFF 2040 kb).
10143_2017_929_MOESM2_ESM.doc (30 kb)
Supplemental Table 1 (DOC 29 kb).
10143_2017_929_MOESM3_ESM.doc (32 kb)
Supplemental Table 2 (DOC 32 kb).


  1. 1.
    Andersson T, Kihlstrom L, Soderman M (2004) Regression of a flow-related ophthalmic artery aneurysm after treatment of a frontal DAVS. A case report. Interv Neuroradiol 10(3):265–268. CrossRefGoogle Scholar
  2. 2.
    Borden JA, JK W, Shucart WA (1995) A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82(2):166–179. CrossRefGoogle Scholar
  3. 3.
    Cagnazzo F, Brinjikji W, Lanzino G (2016) Arterial aneurysms associated with arteriovenous malformations of the brain: classification, incidence, risk of hemorrhage, and treatment—a systematic review. Acta Neurochir 158(11):2095–2104. CrossRefGoogle Scholar
  4. 4.
    Chen Z, Zhu G, Feng H, Tang W, Wang X (2008) Dural arteriovenous fistula of the anterior cranial fossa associated with a ruptured ophthalmic aneurysm: case report and review of the literature. Surg Neurol 69(3):318–321. CrossRefGoogle Scholar
  5. 5.
    Della Pepa GM, Sabatino G, La Rocca G, Scerrati A, Maira G, Albanese A, Marchese E (2014) Intraorbital and intracanalicular ophthalmic artery aneurysms. Literature review and report of a case. Br J Neurosurg 28(6):787–790. CrossRefGoogle Scholar
  6. 6.
    Gacs G, Vinuela F, Fox AJ, Drake CG (1983) Peripheral aneurysms of the cerebellar arteries. Review of 16 cases. J Neurosurg 58(1):63–68. CrossRefGoogle Scholar
  7. 7.
    Gilard V, Curey S, Tollard E, Proust F (2013) Coincidental vascular anomalies at the foramen magnum: dural arteriovenous fistula and high flow aneurysm on perimedullary fistula. Neurochirurgie 59(6):210–213. CrossRefGoogle Scholar
  8. 8.
    Gross BA, Du R (2012) The natural history of cerebral dural arteriovenous fistulae. Neurosurgery 71(3):594–602; discussion 602-593. CrossRefGoogle Scholar
  9. 9.
    Gross BA, Ropper AE, Du R (2012) Cerebral dural arteriovenous fistulas and aneurysms. Neurosurg Focus 32(5):E2. CrossRefGoogle Scholar
  10. 10.
    Ishikawa T, Houkin K, Tokuda K, Kawaguchi S, Kashiwaba T (1997) Development of anterior cranial fossa dural arteriovenous malformation following head trauma. Case report. J Neurosurg 86(2):291–293. CrossRefGoogle Scholar
  11. 11.
    Kaech D, de Tribolet N, Lasjaunias P (1987) Anterior inferior cerebellar artery aneurysm, carotid bifurcation aneurysm, and dural arteriovenous malformation of the tentorium in the same patient. Neurosurgery 21(4):575–582. CrossRefGoogle Scholar
  12. 12.
    Kan P, Stevens EA, Warner J, Couldwell WT (2007) Resolution of an anterior-inferior cerebellar artery feeding aneurysm with the treatment of a transverse-sigmoid dural arteriovenous fistula. Skull Base 17(3):205–210. CrossRefGoogle Scholar
  13. 13.
    Kawaguchi S, Sakaki T, Okuno S, Uchiyama Y, Nishioka T (2001) Peripheral ophthalmic artery aneurysm. Report of two cases. J Neurosurg 94(5):822–825. CrossRefGoogle Scholar
  14. 14.
    Kikuchi K, Kowada M (1994) Anterior fossa dural arteriovenous malformation supplied by bilateral ethmoidal arteries. Surg Neurol 41(1):56–64. CrossRefGoogle Scholar
  15. 15.
    Kirsch M, Henkes H (2011) A ruptured intraorbital ophthalmic artery aneurysm, associated with a dural arteriovenous fistula: combined transarterial and transvenous endovascular treatment. Minim Invasive Neurosurg 54(03):128–131. CrossRefGoogle Scholar
  16. 16.
    Kleinschmidt A, Sullivan TJ, Mitchell K (2004) Intraorbital ophthalmic artery aneurysms. Clin Exp Ophthalmol 32(1):112–114. CrossRefGoogle Scholar
  17. 17.
    Ko A, Filardi T, Giussani C, Ghodke R, Browd SR (2010) An intracranial aneurysm and dural arteriovenous fistula in a newborn. Pediatr Neurosurg 46(6):450–456. CrossRefGoogle Scholar
  18. 18.
    Kohyama S, Yamane F, Ishihara H, Uemiya N, Ishihara S (2015) Rupture of an aneurysm of the superior cerebellar artery feeding a dural arteriovenous fistula. J Stroke Cerebrovasc Dis 24(5):e105–e107. CrossRefGoogle Scholar
  19. 19.
    Li M, Lin N, Wu J, Liang J, He W (2012) Multiple intracranial aneurysms associated with multiple dural arteriovenous fistulas and cerebral arteriovenous malformation. World Neurosurg 77(398):E311–E395Google Scholar
  20. 20.
    Martin NA, King WA, Wilson CB, Nutik S, Carter LP, Spetzler RF (1990) Management of dural arteriovenous malformations of the anterior cranial fossa. J Neurosurg 72(5):692–697. CrossRefGoogle Scholar
  21. 21.
    Meneghelli P, Pasqualin A, Lanterna LA, Bernucci C, Spinelli R, Dorelli G, Zampieri P (2017) Surgical treatment of anterior cranial fossa dural arterio-venous fistulas (DAVFs): a two-centre experience. Acta Neurochir 159(5):823–830. CrossRefGoogle Scholar
  22. 22.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341. CrossRefGoogle Scholar
  23. 23.
    Murai Y, Yamashita Y, Ikeda Y, Node Y, Teramoto A (1999) Ruptured aneurysm of the orbitofrontal artery associated with dural arteriovenous malformation in the anterior cranial fossa—case report. Neurol Med Chir (Tokyo) 39(2):157–160. CrossRefGoogle Scholar
  24. 24.
    Muro K, Adel JG, Gottardi-Littell NR, Getch CC, Batjer HH (2010) True aneurysm on the posterior meningeal artery associated with a dural arteriovenous fistula: case report. Neurosurgery 67(3):E876–E877. CrossRefGoogle Scholar
  25. 25.
    Onu DO, Hunn AW, Harle RA (2013) A rare association of cerebral dural arteriovenous fistula with venous aneurysm and contralateral flow-related middle cerebral artery aneurysm. BMJ Case Rep 2013(sep19 1):bcr2013200764. CrossRefGoogle Scholar
  26. 26.
    Preul M, Tampieri D, Leblanc R (1992) Giant aneurysm of the distal anterior cerebral artery: associated with an anterior communicating artery aneurysm and a dural arteriovenous fistula. Surg Neurol 38(5):347–352. CrossRefGoogle Scholar
  27. 27.
    Reinard K, Basheer A, Pabaney A, Marin H, Malik G (2014) Spontaneous resolution of a flow-related ophthalmic-segment aneurysm after treatment of anterior cranial fossa dural arteriovenous fistula. Surg Neurol Int 5(Suppl 14):S512–S515. CrossRefGoogle Scholar
  28. 28.
    Rumboldt Z, Beros V, Klanfar Z (2003) Multiple cerebral aneurysms and a dural arteriovenous fistula in a patient with polyarteritis nodosa. Case illustration. J Neurosurg 98(2):434. CrossRefGoogle Scholar
  29. 29.
    Sanchis JF, Orozco M, Cabanes J (1975) Spontaneous extradural haematomas. J Neurol Neurosurg Psychiatry 38(6):577–580. CrossRefGoogle Scholar
  30. 30.
    Sato K, Shimizu T, Fukuhara T, Namba Y (2011) Ruptured anterior communicating artery aneurysm associated with anterior cranial fossa dural arteriovenous fistula—case report. Neurol Med Chir (Tokyo) 51(1):40–44. CrossRefGoogle Scholar
  31. 31.
    Suzuki S, Tanaka R, Miyasaka Y, Kurata A, Takano M, Fujii K, Takagi H (2000) Dural arteriovenous malformations associated with cerebral aneurysms. J Clin Neurosci 7(Suppl 1):36–38. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity of PisaPisaItaly
  2. 2.Departments of Neurologic Surgery and Radiology, Mayo ClinicMayo Medical SchoolRochesterUSA

Personalised recommendations