70 - Dural Arteriovenous Malformations

Abstract

Intracranial dural arteriovenous malformations (DAVMs) are pathologic anastomoses between meningeal arteries and dural venous sinuses or cortical veins. These typically reside within the dural leaflets surrounding a venous sinus. DAVMs are unique in that their arterial supply is from vessels that supply the dura and lack of a parenchymal nidus. DAVM are rare, accounting for 5%–15% of all intracranial vascular malformations, generally affecting patients in their fifth to sixth decade of life. Clinical manifestations vary widely and are multifactorial. Simplified classification of DAVMs is based on two main factors: 1) previous hemorrhage and/or 2) the presence of retrograde leptomeningeal venous drainage. Treatment options can include observation, stereotactic radiosurgery, microsurgical resection, endovascular embolization, or a combination of these approaches. The etiology of DAVMs is thought to occur from a hypercoagulable state, and patients should undergo an expanded venous hypercoagulable workup to identify modifiable conditions.