Abstract
Intracranial dural AVFs are abnormal communications between arteries that supply the dura mater and draining cortical veins or venous sinuses. They are believed to form as a response to venous insults such as thrombosis, trauma, or infection. Classification and management are dependent on the presence of drainage/reflux into cortical veins because such drainage markedly elevates the risk of hemorrhage or venous congestion, resulting in neurologic deficits. AVFs with tolerable symptoms and benign drainage patterns can be managed conservatively. Intolerable symptoms, presentation with hemorrhage/neurologic deficits, or aggressive drainage patterns are indications for intervention. Treatment options include microsurgical disconnection, endovascular transarterial embolization, transvenous embolization, or a combination. This is the first in a series of 3 articles on endovascular management of intracranial dural AVFs, in which we outline the principles and outcomes of endovascular treatment.
Highlights
These additional techniques allow us to identify external carotid artery (ECA)-ICA anastomoses and cranial nerve arterial supplies that may be at risk during endovascular treatment and reduce our treatment-related risk profile
We undertake detailed anatomic assessment of the DSA imaging to assist in management decision-making via a 4-step process: 1. Benign vs aggressive: We determine whether the AVF is angiographically benign or aggressive on the basis of the absence or presence of cortical venous reflux/drainage
D, Axial TOF-MRA image demonstrates pathologic hyperintense signal in the left petrosal vein due to pre-excited protons entering via the high-flow left petrosal dural AVFs (dAVFs)
Summary
Consideration of a diagnosis of dAVF may be based initially on the clinical presentation and noncontrast imaging findings. These additional techniques allow us to identify external carotid artery (ECA)-ICA anastomoses and cranial nerve arterial supplies that may be at risk during endovascular treatment and reduce our treatment-related risk profile. We undertake detailed anatomic assessment of the DSA imaging (including 3D rotational angiography with MPRs) to assist in management decision-making via a 4-step process: 1. Benign vs aggressive: We determine whether the AVF is angiographically benign or aggressive on the basis of the absence or presence of cortical venous reflux/drainage
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