Skip to main content

Classifications of Cranial and Spinal Dural Arteriovenous Fistulas and Their Endovascular Embolization

  • Chapter
  • First Online:
Intracranial and Spinal Dural Arteriovenous Fistulas
  • 298 Accesses

Abstract

Dural arteriovenous fistula (DAVF) represents approximately 10–15% of all intracranial vascular malformations. DAVFs can be benign lesions, but the angioarchitecture of retrograde venous drainage or cortical venous reflux makes these lesions an aggressive high risk of neurological deficits and mortality caused by rupture or venous congestion. Endovascular embolization is the first line treatment for DAVF. Both transarterial and transvenous approaches have expanded the complex DAVFs that we can treat. The selection of endovascular approach depends on the angioarchitecture of the DAVF and experiences of neurosurgeons, the feeding arteries, lesion location, venous outflow direction. Surgery and stereotactic radiosurgery are used in few cases that endovascular approaches are impossible or unsuccessful.

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 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
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. Djindjian R, Merland JJ. Superselective arteriography of the external carotid artery. Berlin: Springer; 1978.

    Book  Google Scholar 

  2. Lv X, Wu Z, Li Y. Innervation of cerebral dura mater. Neuroradiol J. 2014;27(3):293–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Borden JA, Wu JK, Shncart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg. 1995;82:166–79.

    Article  CAS  PubMed  Google Scholar 

  4. 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;194:671–80.

    Article  CAS  PubMed  Google Scholar 

  5. Alexander MD, Halbach VV, Hallam DK, Cooke DL, Ghodke BV, Dowd CF, Amans MR, Hetts SW, Higashida RT, Meyers PM. Long-term outcomes of endovascular treatment of indirect carotid cavernous fistulae: superior efficacy, safety, and durability of transvenous coiling over other techniques. Neurosurgery. 2019;85(1):E94–E100.

    Article  PubMed  Google Scholar 

  6. Bernstein R, Dowd CF,Gress DR. Rapidly reversible dementia. Lancet. 2003;361:392.

    Article  CAS  PubMed  Google Scholar 

  7. Jin H, Lv X, Li Y. Transarterial Onyx embolization of jugular foramen dural arteriovenous fistula with spinal venous drainage manifesting as myelopathy-a case report and review of the literature. Interv Neuroradiol. 2016;22(5):579–83.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Li T, Lv X, Wu Z. Endovascular treatment of hemifacial spasm associated with a petrosal DAVF using transarterial Onyx embolization: case report. Interv Neuroradiol. 2012;18:69–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Lv X, Yang X, Li Y, Jiang C, Wu Z. Dural arteriovenous fistula with spinal perimedullary venous drainage. Neurology India. 2011;59:899–902.

    Article  PubMed  Google Scholar 

  10. Lv X, Jiang C, Li Y, Yang X, Wu Z. Isolated oculomotor nerve palsy in interventional neuroradiology. Eur J Radiol. 2010;74:441–4.

    Article  PubMed  Google Scholar 

  11. Lv X, Zhang J, Li Y, Jiang C, Wu Z. Dural arteriovenous fistula involving the transverse sigmoid sinus presenting as chemosis: a case report. Neuroradiol J. 2008;21:428–32.

    Article  PubMed  Google Scholar 

  12. Cognard C, Januel AC, Silva NA Jr, Tall P. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol. 2008;29:235–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Zipfel GJ, Shah MN, Refai D, Dacey RG Jr, Derdeyn CP. Cranial dural arteriovenous fistulas: modification of angiographic classification scales based on new natural history data. Neurosurg Focus. 2009;26(5):E14.

    Article  PubMed  Google Scholar 

  14. Macdonald JHM, Millar JS, Barker CS. Endovascular treatment of cranial dural arteriovenous fistulae: a single-centre, 14-year experience and the impact of Onyx on local practise. Neuroradiology. 2010;52:387–95.

    Article  PubMed  Google Scholar 

  15. Sirakov SS, Sirakov A, Minkin K, Hristov H, Ninov K, Penkov M, Karakostov V, Orlov K, Gorbatykh A, Kislitsin D, Raychev R. Initial experience with precipitating hydrophobic injectable liquid in cerebral arteriovenous malformations. Interv Neuroradiol. 2019;25(1):58–65.

    Article  PubMed  Google Scholar 

  16. Varadharajan S, Ramalingaiah AH, Saini J, Gupta AK, Devi BI, Acharya UV. Precipitating hydrophobic injectable liquid embolization of intracranial vascular shunts: initial experience and technical note. J Neurosurg. 2018;129(5):1217–22.

    Article  PubMed  Google Scholar 

  17. Gioppo A, Faragò G, Caldiera V, Caputi L, Cusin A, Ciceri E. Medial tentorial dural arteriovenous fistula embolization: single experience with embolic liquid polymer SQUID and review of the literature. World Neurosurg. 2017;107:1050.e1–7.

    Article  Google Scholar 

  18. Castaño C, Remollo S, García-Sort R, et al. Treatment of Barrow type ‘B’ carotid cavernous fistulas with flow diverter stent (Pipeline). Neuroradiol J. 2017;30:607–14.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mossa-Basha M, Chen J, Gandhi D. Imaging of cerebral arteriovenous malformations and dural arteriovenous fistulas. Neurosurg Clin N Am. 2012;23:27–42.

    Article  PubMed  Google Scholar 

  20. Nelson PK, Russell SM, Woo HH, et al. 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. 2003;98:498–506.

    Article  PubMed  Google Scholar 

  21. Moore C, Murphy K, Gailloud P. Improved distal distribution of n-butyl cyanoacrylate glue by simultaneous injection of dextrose 5% through the guiding catheter: technical note. Neuroradiology. 2006;48:327–32.

    Article  PubMed  Google Scholar 

  22. Guedin P, Gaillard S, Boulin A, et al. Therapeutic management of intracranial dural arteriovenous shunts with leptomeningeal venous drainage: report of 53 consecutive patients with emphasis on transarterial embolization with acrylic glue. J Neurosurg. 2010;112:603–10.

    Article  PubMed  Google Scholar 

  23. Baharvahdat H, Ooi YC, Kim WJ, Mowla A, Coon AL, Colby GP. Updates in the management of cranial dural arteriovenous fistula. Stroke Vasc Neurol. 2019;5(1):50–8.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kirsch M, Liebig T, Kühne D, et al. Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients. Neuroradiology. 2009;51:477–83.

    Article  CAS  PubMed  Google Scholar 

  25. Nogueira RG, Dabus G, Rabinov JD, et al. Preliminary experience with onyx embolization for the treatment of intracranial dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2008;29:91–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Jiang C, Lv X, Li Y, et al. Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes. Neuroradiology. 2009;51:103–11.

    Article  PubMed  Google Scholar 

  27. Cognard C, Januel AC, Silva NA, et al. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol. 2008;29:235–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Rabinov JD, Yoo AJ, Ogilvy CS, et al. ONYX versus n-BCA for embolization of cranial dural arteriovenous fistulas. J Neurointerv Surg. 2013;5:306–10.

    Article  PubMed  Google Scholar 

  29. Leyon JJ, Chavda S, Thomas A, et al. Preliminary experience with the liquid embolic material agent PHIL (precipitating hydrophobic injectable liquid) in treating cranial and spinal dural arteriovenous fistulas: technical note. J Neurointerv Surg. 2016;8:596–602.

    Article  PubMed  Google Scholar 

  30. Lamin S, Chew HS, Chavda S, et al. Embolization of intracranial dural arteriovenous fistulas using PHIL liquid embolic agent in 26 patients: a multicenter study. AJNR Am J Neuroradiol. 2017;38:127–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Akmangit I, Daglioglu E, Kaya T, et al. Preliminary experience with squid: a new liquid embolizing agent for AVM, AV fistulas and tumors. Turk Neurosurg. 2014;24:565–70.

    PubMed  Google Scholar 

  32. McConnell KA, Tjoumakaris SI, Allen J, et al. Neuroendovascular management of dural arteriovenous malformations. Neurosurg Clin N Am. 2009;20:431–9.

    Article  PubMed  Google Scholar 

  33. Natarajan SK, Ghodke B, Kim LJ, et al. Multimodality treatment of intracranial dural arteriovenous fistulas in the Onyx era: a single center experience. World Neurosurg. 2010;73:365–79.

    Article  PubMed  Google Scholar 

  34. Suzuki S, Lee DW, Jahan R, et al. Transvenous treatment of spontaneous dural carotid-cavernous fistulas using a combination of detachable coils and Onyx. AJNR Am J Neuroradiol. 2006;27:1346–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Alexander MD, Halbach VV, Hallam DK, et al. Long-term outcomes of endovascular treatment of indirect carotid cavernous fistulae: superior efficacy, safety, and durability of transvenous coiling over other techniques. Neurosurgery. 2019;85:E94–100.

    Article  PubMed  Google Scholar 

  36. Caplan JM, Kaminsky I, Gailloud P, et al. A single burr hole approach for direct transverse sinus cannulation for the treatment of a dural arteriovenous fistula. J Neurointerv Surg. 2015;7:e5.

    Article  PubMed  Google Scholar 

  37. Layton KF. Embolization of an intracranial dural arteriovenous fistula using ultrasound-guided puncture of a pericranial venous pouch. Proc (Bayl Univ Med Cent). 2009;22:332–4.

    Google Scholar 

  38. Wong GKC, Poon WS, Yu SCH, et al. Transvenous embolization for dural transverse sinus fistulas with occluded sigmoid sinus. Acta Neurochir. 2007;149:929–36.

    Article  CAS  PubMed  Google Scholar 

  39. Naito I, Iwai T, Shimaguchi H, et al. Percutaneous transvenous embolisation through the occluded sinus for transverse-sigmoid dural arteriovenous fistulas with sinus occlusion. Neuroradiology. 2001;43:672–6.

    Article  CAS  PubMed  Google Scholar 

  40. Komiyama M, Ishiguro T, Matsusaka Y, et al. Transfemoral, transvenous embolisation of dural arteriovenous fistula involving the isolated transverse-sigmoid sinus from the contralateral side. Acta Neurochir. 2002;144:1041–6.

    Article  CAS  PubMed  Google Scholar 

  41. Dashti SR, Fiorella D, Spetzler RF, et al. Transorbital endovascular embolization of dural carotid-cavernous fistula: access to cavernous sinus through direct puncture: case examples and technical report. Neurosurgery. 2011;68:75–83.

    PubMed  Google Scholar 

  42. Gil A, López-Ibor L, Lopez-Flores G, et al. Treatment of a carotid cavernous fistula via direct transovale cavernous sinus puncture. J Neurosurg. 2013;119:247–51.

    Article  PubMed  Google Scholar 

  43. Shi Z-S, Loh Y, Gonzalez N, et al. Flow control techniques for Onyx embolization of intracranial dural arteriovenous fistulae. J Neurointerv Surg. 2013;5:311–6.

    Article  PubMed  Google Scholar 

  44. Bhatia KD, Wang L, Parkinson RJ, et al. Successful treatment of six cases of indirect carotid-cavernous fistula with ethylene vinyl alcohol copolymer (Onyx) transvenous embolization. J Neuroophthalmol. 2009;29:3–8.

    Article  PubMed  Google Scholar 

  45. Albuquerque FC, Ducruet AF, Crowley RW, et al. Transvenous to arterial Onyx embolization. J Neurointerv Surg. 2014;6:281–5.

    Article  PubMed  Google Scholar 

  46. Spiotta AM, Hawk H, Kellogg RT, et al. Transfemoral venous approach for Onyx embolization of anterior fossa dural arteriovenous fistulae. J Neurointerv Surg. 2014;6:195–9.

    Article  PubMed  Google Scholar 

  47. Kerolus MG, Chung J, Munich SA, et al. An Onyx tunnel: reconstructive transvenous balloon-assisted Onyx embolization for dural arteriovenous fistula of the transverse-sigmoid sinus. J Neurosurg. 2018;129:922–7.

    Article  PubMed  Google Scholar 

  48. Lv X, Jiang C, Liang S, Wang J. The variant with the absence of the superior petrosal venous and sinus: a potential pitfall of transvenous balloon-assisted embolisation of Borden type II transverse-sigmoid dural arteriovenous fistula. Interv Neuroradiol. 2019;25(4):474–7.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ye M, Zhang P. Transvenous balloon-assisted Onyx embolization of dural arteriovenous fistulas of hypoglossal canal. Neuroradiology. 2018;60:971–8.

    Article  PubMed  Google Scholar 

  50. Levrier O, Métellus P, Fuentes S, et al. Use of a self-expanding stent with balloon angioplasty in the treatment of dural arteriovenous fistulas involving the transverse and/or sigmoid sinus: functional and neuroimaging-based outcome in 10 patients. J Neurosurg. 2006;104:254–63.

    Article  PubMed  Google Scholar 

  51. See AP, Raza S, Tamargo RJ, et al. Stereotactic radiosurgery of cranial arteriovenous malformations and dural arteriovenous fistulas. Neurosurg Clin N Am. 2012;23:133–46.

    Article  PubMed  Google Scholar 

  52. Cifarelli CP, Kaptain G, Yen C-P, et al. Gamma knife radiosurgery for dural arteriovenous fistulas. Neurosurgery. 2010;67:1230–5.

    Article  PubMed  Google Scholar 

  53. H.-C. Y, Kano H, Kondziolka D, et al. Stereotactic radiosurgery with or without embolization for intracranial dural arteriovenous fistulas. Neurosurgery. 2010;67:1276–85.

    Article  Google Scholar 

  54. Koebbe CJ, Singhal D, Sheehan J, et al. Radiosurgery for dural arteriovenous fistulas. Surg Neurol. 2005;64:392–8.

    Article  PubMed  Google Scholar 

  55. Söderman M, Edner G, Ericson K, et al. Gamma knife surgery for dural arteriovenous shunts: 25 years of experience. J Neurosurg. 2006;104:867–75.

    Article  PubMed  Google Scholar 

  56. Collice M, D’Aliberti G, Arena O, et al. Surgical treatment of intracranial dural arteriovenous fistulae: role of venous drainage. Neurosurgery. 2000;47:56–66.

    CAS  PubMed  Google Scholar 

  57. Thompson BG, Doppman JL, Oldfield EH. Treatment of cranial dural arteriovenous fistulae by interruption of leptomeningeal venous drainage. J Neurosurg. 1994;80:617–23.

    Article  CAS  PubMed  Google Scholar 

  58. Kakarla UK, Deshmukh VR, Zabramski JM, et al. Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications. Neurosurgery. 2007;61:447–57.

    Article  PubMed  Google Scholar 

  59. Schuette AJ, Cawley CM, Barrow DL. Indocyanine green videoangiography in the management of dural arteriovenous fistulae. Neurosurgery. 2010;67:658–62.

    Article  PubMed  Google Scholar 

  60. Giannopoulos S, Texakalidis P, Mohammad Alkhataybeh RA, et al. Treatment of ethmoidal dural arteriovenous fistulas: a meta-analysis comparing endovascular versus surgical treatment. World Neurosurg. 2019;128:593–9.

    Article  PubMed  Google Scholar 

  61. Oh SH, Choi JH, Kim B-S, et al. Treatment outcomes according to various treatment modalities for intracranial dural arteriovenous fistulas in the Onyx era: a 10-year single-center experience. World Neurosurg. 2019;126:e825–34.

    Article  PubMed  Google Scholar 

  62. Casasco A, Guimaraens L, Negrotto M, Vivas E, Díaz LP, Aleu A. A new subtype of intracranial dural AVF according to the patterns of venous drainage. Interv Neuroradiol. 2021;27(1):121–8.

    Article  PubMed  Google Scholar 

  63. Kim DJ, Kim DI, Suh SH, Kim J, Lee SK, Kim EY, et al. Results of transvenous embolization of cavernous dural arteriovenous fistula: a single-center experience with emphasis on complications and management. AJNR Am J Neuroradiol. 2006;27:2078–82.

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Lv X, Jiang C, Li Y, Lv M, Wu Z. Endovascular treatment of dural fistulas with the venous outflow of laterocavernous sinus. Eur J Radiol. 2010;75:e129–34.

    Article  PubMed  Google Scholar 

  65. Nakagawa I, Wada T, Nakagawa H, Hironaka Y, Kichikawa K, Nakase H. A rare brainstem hemorrhage during transvenous embolization of a cavernous dural arteriovenous fistula. J Clin Neurosci. 2012;19:589–92.

    Article  PubMed  Google Scholar 

  66. Wakhloo AK, Perlow A, Linfante I, Sandhu JS, Cameron J, Troffkin N, Schenck A, Schatz NJ, Tse DT, Lam BL. Transvenous n-butyl-cyanoacrylate infusion for complex dural carotid cavernous fistulas: technical considerations and clinical outcome. AJNR Am J Neuroradiol. 2005;26:1888–97.

    PubMed  PubMed Central  Google Scholar 

  67. Lv X, Jiang C, Li Y, Yang X, Wu Z. Transarterial embolization of tentorial dural arteriovenous fistulas with Onyx-18. Neuroradiol J. 2008;21:406–14.

    Article  PubMed  Google Scholar 

  68. Lv X, Wang G, Wang J. Craniospinal vascular diseases and endovascular neurosurgery. New York: Nova Science Publisher; 2021.

    Google Scholar 

  69. Lv X, Jiang C, Li Y, Liu L, Liu J, Wu Z. The limitations and risks of transarterial Onyx injections in the treatment of grade I and II DAVFs. Eur J Radiol. 2011;80:e385–8.

    Article  PubMed  Google Scholar 

  70. Lv X, Jiang C, Li Y, Wu Z. Results and complications of transarterial embolization of intracranial dural arteriovenous fistulas using Onyx-18. J Neurosurg. 2008;109:1083–90.

    Article  PubMed  Google Scholar 

  71. Gatto LAM, Saurin F, Koppe GL, Demartini Z Jr. Facial palsy after embolization of dural arteriovenous fistula: a case report and literature review. Surg Neurol Int. 2017;8:270.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Lv XL. Accessory meningeal artery: emphasis on its intracranial distribution. J Cerebrovasc Dis. 2019;2(1):1–3.

    Google Scholar 

  73. Lv X, Jiang C, Zhang J, Li Y, Wu Z. Complications related to percutaneous transarterial embolization of intracranial dural arteriovenous fistulas in 40 patients. Am J Neuroradiol. 2009;30:462–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. de Carvalho JC, Machin FJ, Manzanera LS, Andaluz JB, Nogues SH, Soriano NP, et al. Intraventricular hemorrhage after dural fistula embolization. Braz J Anesthesiol. 2017;67:199–204.

    Article  PubMed  Google Scholar 

  75. Piippo A, Niemela M. Hemodynamic changes caused by the occlusion of dural arteriovenous fistula. World Neurosurg. 2013;80:e211–2.

    Article  PubMed  Google Scholar 

  76. Liu P, Chen X, You W, Li Y, Lv M, Lv X. Hemorrhagic risk factors of endovascular onyx embolization of intracranial dural arteriovenous fistulas. Interv Neuroradiol. 2020;26(5):643–50.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Zhang, H., Lv, X. (2022). Classifications of Cranial and Spinal Dural Arteriovenous Fistulas and Their Endovascular Embolization. In: Lv, X. (eds) Intracranial and Spinal Dural Arteriovenous Fistulas. Springer, Singapore. https://doi.org/10.1007/978-981-19-5767-3_1

Download citation

  • DOI: https://doi.org/10.1007/978-981-19-5767-3_1

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-5766-6

  • Online ISBN: 978-981-19-5767-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics