Skip to main content

Dural Arteriovenous Fistulae: Surgical Indications and Technique

  • Chapter
  • First Online:
Management of Cerebrovascular Disorders

Abstract

Dural arteriovenous fistulae are rare lesions with a wide range of manifestations and clinical courses. Lesions with cortical venous drainage (CVD) have a poor natural history and warrant treatment. Endovascular therapy is a good option for many dAVF, while surgery may be indicated for cases with unsuitable transarterial or transvenous access, perceived risk of neurologic deficits from embolization, and persistence of the fistula after previous embolization attempts. The operative strategy is dictated by whether the lesion involves a dural venous sinus or has solely cortical venous drainage, and the surgical approach is chosen to provide the best exposure to the fistula and its venous outflow.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Al-Shahi R, Bhattacharya JJ, Currie DG, Papanastassiou V, Ritchie V, Roberts RC, Sellar RJ, Warlow CP. Prospective, population-based detection of intracranial vascular malformations in adults: the Scottish Intracranial Vascular Malformation Study (SIVMS). Stroke. 2003;34:1163.

    Article  Google Scholar 

  2. Signorelli F, Della Pepa GM, Sabatino G, Marchese E, Maira G, Puca A, Albanese A. Diagnosis and management of dural arteriovenous fistulas: a 10 years single-center experience. Clin Neurol Neurosurg. 2015;128:123.

    Article  CAS  Google Scholar 

  3. Lasjaunias P, Chiu M, ter Brugge K, Tolia A, Hurth M, Bernstein M. Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg. 1986;64:724.

    Article  CAS  Google Scholar 

  4. El Asri AC, El Mostarchid B, Akhaddar A, Naama O, Gazzaz M, Boucetta M. Factors influencing the prognosis in intracranial dural arteriovenous fistulas with perimedullary drainage. World Neurosurg. 2013;79:182.

    Article  Google Scholar 

  5. Celik O, Piippo A, Romani R, Navratil O, Laakso A, Lehecka M, Dashti R, Niemelä M, Rinne J, Jääskeläinen JE, Hernesniemi J. Management of dural arteriovenous fistulas – Helsinki and Kuopio experience. Acta Neurochir Suppl. 2010;107:77.

    Article  CAS  Google Scholar 

  6. Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg. 1995;82:166.

    Article  CAS  Google Scholar 

  7. Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, Chiras J, Merland JJ. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995;194:671.

    Article  CAS  Google Scholar 

  8. Zipfel GJ, Shah MN, Refai D, Dacey RG, Derdeyn CP. Cranial dural arteriovenous fistulas: modification of angiographic classification scales based on new natural history data. Neurosurg Focus. 2009;26:E14.

    Article  Google Scholar 

  9. Söderman M, Pavic L, Edner G, Holmin S, Andersson T. Natural history of dural arteriovenous shunts. Stroke. 2008;39:1735.

    Article  Google Scholar 

  10. Strom RG, Botros JA, Refai D, Moran CJ, Dewittet Cross III, Chicoine MR, Grubb RL, Rich KM, Dacey RG, Derdeyn CP, Zipfel GJ. Cranial dural arteriovenous fistulae: asymptomatic cortical venous drainage portends less aggressive clinical course. Neurosurgery. 2009;64:241.

    Article  Google Scholar 

  11. Satomi J, van Dijk JM, 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. 2002;97:767.

    Article  Google Scholar 

  12. Van Dijk JMC, TerBrugge KG, Willinsky RA, Wallace MC. Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke. 2002;33:1233.

    Article  Google Scholar 

  13. Chen C-J, Lee C-C, Ding D, Starke RM, Chivukula S, Yen C, Moosa S, Xu Z, Pan DH-C, Sheehan JP. J Neurosurg. 2015;122:353.

    Article  Google Scholar 

  14. van Dijk JMC, TerBrugge KG, Willinsky RA, Wallace MC. Stereotactic radiosurgery for intracranial dural arteriovenous fistulas: a systematic review. J. Neurosurg. 2004;101:31.

    Article  Google Scholar 

  15. Duffau H, Lopes M, Janosevic V, Sichez JP, Faillot T, Capelle L, Ismaïl M, Bitar A, Arthuis F, Fohanno D. Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature. J Neurosurg. 1999;90:78.

    Article  CAS  Google Scholar 

  16. Sundt TM, Piepgras DG. Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature. J Neurosurg. 1983;59:32.

    Article  Google Scholar 

  17. Eftekhar B, Morgan MK. Surgical management of dural arteriovenous fistulas of the transverse-sigmoid sinus in 42 patients. J Clin Neurosci. 2013;20:532.

    Article  Google Scholar 

  18. Ojemann R, Heros R, Crowell R. Surgical management of cerebrovascular disease. 2nd ed. Baltimore: Williams & Wilkins; 1988. p. 415–25.

    Google Scholar 

  19. Grisoli F, Vincentelli F, Fuchs S, Baldini M, Raybaud C, Leclercq TA, Vigouroux RP. Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space. Report of four cases. J Neurosurg. 1984;60:1059.

    Article  CAS  Google Scholar 

  20. Thompson BG, Doppman JL, Oldfield EH. Treatment of cranial dural arteriovenous fistulae by interruption of leptomeningeal venous drainage. J Neurosurg. 1994;80:617.

    Article  CAS  Google Scholar 

  21. Collice M, D’Aliberti G, Talamonti G, Branca V, Boccardi E, Scialfa G, Versari PP. Surgical interruption of leptomeningeal drainage as treatment for intracranial dural arteriovenous fistulas without dural sinus drainage. J Neurosurg. 1996;84:810.

    Article  CAS  Google Scholar 

  22. Lawton MT, Chun J, Wilson CB, Halbach VV. Ethmoidal dural arteriovenous fistulae: an assessment of surgical and endovascular management. Neurosurgery. 1999;45:805.

    Article  CAS  Google Scholar 

  23. Endo S, Kuwayama N, Takaku A, Nishijima M. Direct packing of the isolated sinus in patients with dural arteriovenous fistulas of the transverse-sigmoid sinus. J Neurosurg. 1998;88:449.

    Article  CAS  Google Scholar 

  24. Houdart E, Saint-Maurice J-P, Chapot R, Ditchfield A, Blanquet A, Lot G, Merland J-J. Transcranial approach for venous embolization of dural arteriovenous fistulas. J Neurosurg. 2002;97:280.

    Article  Google Scholar 

  25. Lawton MT, Sanchez-Mejia RO, Pham D, Tan J, Halbach VV. Tentorial dural arteriovenous fistulae: operative strategies and microsurgical results for six types. Neurosurgery. 2008;62:110.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alex M. Witek .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Witek, A.M., Dudley, T.M., Bain, M.D. (2019). Dural Arteriovenous Fistulae: Surgical Indications and Technique. In: Spiotta, A., Turner, R., Chaudry, M., Turk, A. (eds) Management of Cerebrovascular Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-99016-3_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-99016-3_20

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-99015-6

  • Online ISBN: 978-3-319-99016-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics