Intracranial Dural Arteriovenous Fistulae

Abstract

Dural arteriovenous fistulae (DAVF) are a rare type of acquired intracranial vascular malformation consisting of a pathological shunt located within the dura matter of the brain.1–3 In contradistinction to brain arteriovenous malformations, DAVFs do not harbor a focal nidus.1 These lesions may arise anywhere along the dura, but most commonly are found in the region of the transverse, sigmoid, and cavernous sinuses.2,4–6 DAVF are typically supplied by meningeal arteries and exhibit venous drainage either directly into the dural venous sinuses or via cortical and meningeal veins.2,3 Larger, more complex lesions may recruit pial arterial supply.3 Although a single lesion is present in a majority of patients, multiple shunts can occur in ≤8%.7 DAVF can present with a myriad of clinical signs and symptoms. In general, it is the location and most importantly the venous drainage pattern of DAVF that determines their clinical presentation and potential for serious sequelae.2,8–11 Management strategies for DAVF are consequently guided by these features and include conservative management, as well as endovascular and surgical treatments. This article will begin by reviewing the epidemiology, natural history, and classification of these lesions. Subsequently, clinical presentations, imaging characteristics, and treatment of DAVF will be discussed. DAVF account for only 10% to 15% of intracranial vascular malformations but are slightly over-represented in the posterior fossa (35% of such lesions).4,10 DAVF are typically encountered in middle-aged adults with a median age of onset in the sixth decade.11 Although there is a female predominance, DAVF in men are more likely to display aggressive neurological symptoms and present with hemorrhage.11–13 Rarely, DAVF may be encountered in the pediatric population, where these lesions tend to be more extensive. …