Semin Neurol 2023; 43(03): 388-396
DOI: 10.1055/s-0043-1771453
Review Article

Intracranial Dural Arteriovenous Fistulas

Mohamad Abdalkader
1   Department of Radiology, Boston Medical Center, Boston, Massachusetts
,
Thanh N. Nguyen
2   Department of Neurology, Radiology, and Neurosurgery, Boston Medical Center, Boston, Massachusetts
,
Francesco Diana
3   Interventional Neuroradiology, Vall d'Hebron University Hospital, and Stroke Research Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
,
Shadi Yaghi
4   Rhode Island Hospital, Brown University, Providence, Rhodes Island
,
Liqi Shu
4   Rhode Island Hospital, Brown University, Providence, Rhodes Island
,
Piers Klein
1   Department of Radiology, Boston Medical Center, Boston, Massachusetts
,
Michel E. Mawad
5   Department of Radiology, Lebanese American University - Gilbert and Rose Mary Chagoury School of Medicine, Beirut, Lebanon
,
Raghid Kikano
5   Department of Radiology, Lebanese American University - Gilbert and Rose Mary Chagoury School of Medicine, Beirut, Lebanon
6   Department of Radiology, CISSS de l'Abitibi-Temiscamingue, Québec, Canada
› Author Affiliations

Abstract

Dural arteriovenous fistulas (DAVFs) are abnormal communications between meningeal arteries and dural venous sinuses and/or cortical veins. Although many fistulas are benign and do not require treatment, some may carry a significant risk of bleeding or cause symptoms and warrant treatment. This review provides a review of various aspects of intracranial DAVFs including epidemiology, pathophysiology, clinical presentation, imaging characteristics, classification, natural history, and management options. By exploring these topics, we aim to enhance understanding of this condition and facilitate patient care.



Publication History

Article published online:
10 August 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Nguyen TN, Raymond J, Norbash AM, Roy D. Intracranial dural arteriovenous fistula. In: Qureshi AI, Georgiadis A. eds. Textbook of Interventional Neurology. Cambridge University Press; 2011
  • 2 Chung SJ, Kim JS, Kim JC. et al. Intracranial dural arteriovenous fistulas: analysis of 60 patients. Cerebrovasc Dis 2002; 13 (02) 79-88
  • 3 Kim MS, Han DH, Kwon O-K, Oh C-W, Han MH. Clinical characteristics of dural arteriovenous fistula. J Clin Neurosci 2002; 9 (02) 147-155
  • 4 Gandhi D, Chen J, Pearl M, Huang J, Gemmete JJ, Kathuria S. Intracranial dural arteriovenous fistulas: classification, imaging findings, and treatment. AJNR Am J Neuroradiol 2012; 33 (06) 1007-1013
  • 5 Farb RI, Agid R, Willinsky RA, Johnstone DM, Terbrugge KG. Cranial dural arteriovenous fistula: diagnosis and classification with time-resolved MR angiography at 3T. AJNR Am J Neuroradiol 2009; 30 (08) 1546-1551
  • 6 Newton TH, Cronqvist S. Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 1969; 93 (05) 1071-1078
  • 7 Murai S, Hiramatsu M, Suzuki E. et al; Okayama Cranial and Spinal A-V Shunts (OCSS) Study Group. Trends in incidence of intracranial and spinal arteriovenous shunts: hospital-based surveillance in Okayama, Japan. Stroke 2021; 52 (04) 1455-1459
  • 8 Requejo F, Teplisky D, González Dutra ML, Lipsch J, Nguyen TN, Abdalkader M. Intracranial arteriovenous shunts in infants: A decade of experience from a quaternary pediatric center. Interv Neuroradiol 2023; DOI: 10.1177/15910199231180002.
  • 9 Abdalkader M, Nguyen TN, Diana F, Yaghi S, Shu L, Klein P, Mawad ME, Kikano R. Intracranial Dural Arteriovenous Fistulas. Semin Neurol 2023; 43 (03) 388-396
  • 10 Miller TR, Gandhi D. Intracranial dural arteriovenous fistulae: clinical presentation and management strategies. Stroke 2015; 46 (07) 2017-2025
  • 11 Lindgren E, Rentzos A, Hiltunen S. et al; International CVT Consortium. Dural arteriovenous fistulas in cerebral venous thrombosis: data from the International Cerebral Venous Thrombosis Consortium. Eur J Neurol 2022; 29 (03) 761-770
  • 12 Guniganti R, Giordan E, Chen CJ. et al; Consortium for Dural Arteriovenous Fistula Outcomes Research, CONDOR Collaborators. Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR): rationale, design, and initial characterization of patient cohort. J Neurosurg 2021; 136 (04) 951-961
  • 13 Gross BA, Du R. The natural history of cerebral dural arteriovenous fistulae. Neurosurgery 2012; 71 (03) 594-602 , discussion 602–603
  • 14 Gross BA. Cerebral dural arteriovenous fistulas. Stroke: Vascular and Interventional Neurology 2022; 2 (04) e000532
  • 15 Lawton MT, Jacobowitz R, Spetzler RF. Redefined role of angiogenesis in the pathogenesis of dural arteriovenous malformations. J Neurosurg 1997; 87 (02) 267-274
  • 16 Hamada Y, Goto K, Inoue T. et al. Histopathological aspects of dural arteriovenous fistulas in the transverse-sigmoid sinus region in nine patients. Neurosurgery 1997; 40 (03) 452-456 , discussion 456–458
  • 17 Mullan S. Reflections upon the nature and management of intracranial and intraspinal vascular malformations and fistulae. J Neurosurg 1994; 80 (04) 606-616
  • 18 Cognard C, Januel AC, Silva Jr NA, Tall P. Endovascular treatment of intracranial dural arteriovenous fistulas with cortical venous drainage: new management using Onyx. AJNR Am J Neuroradiol 2008; 29 (02) 235-241
  • 19 Ferro JM, Coutinho JM, Jansen O. et al; RE-SPECT CVT Study Group. Dural arteriovenous fistulae after cerebral venous thrombosis. Stroke 2020; 51 (11) 3344-3347
  • 20 Shoskes A, Shu L, Nguyen TN. et al. Abstract 54: Incidence and predictors of dural arteriovenous fistulae after cerebral venous sinus thrombosis: analysis of ACTION-CVT. Stroke 2023; 54: 54
  • 21 Preter M, Tzourio C, Ameri A, Bousser M-G. Long-term prognosis in cerebral venous thrombosis. Follow-up of 77 patients. Stroke 1996; 27 (02) 243-246
  • 22 Abdalkader M, Nguyen TN, Norbash AM. et al. State of the art: venous causes of pulsatile tinnitus and diagnostic considerations guiding endovascular therapy. Radiology 2021; 300 (01) 2-16
  • 23 van Rooij WJ, Sluzewski M, Beute GN. Dural arteriovenous fistulas with cortical venous drainage: incidence, clinical presentation, and treatment. AJNR Am J Neuroradiol 2007; 28 (04) 651-655
  • 24 Lasjaunias P, Chiu M, ter Brugge K, Tolia A, Hurth M, Bernstein M. Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 1986; 64 (05) 724-730
  • 25 Hurst RW, Bagley LJ, Galetta S. et al. Dementia resulting from dural arteriovenous fistulas: the pathologic findings of venous hypertensive encephalopathy. AJNR Am J Neuroradiol 1998; 19 (07) 1267-1273
  • 26 Kuwayama N. Epidemiologic survey of dural arteriovenous fistulas in Japan: clinical frequency and present status of treatment. Acta Neurochir Suppl (Wien) 2016; 123: 185-188
  • 27 Hernández-Díaz ZM, Llíbre-Guerra JC, Arteche-Prior M. et al. Spontaneous subdural hematoma and behavioral changes due to a dural arteriovenous fistula. a case report and literature review. Behav Sci (Basel) 2019; 9 (06) 63
  • 28 Lin Y-H, Lin H-H, Liu H-M, Lee C-W, Chen Y-F. Diagnostic performance of CT and MRI on the detection of symptomatic intracranial dural arteriovenous fistula: a meta-analysis with indirect comparison. Neuroradiology 2016; 58 (08) 753-763
  • 29 Kwon BJ, Han MH, Kang H-S, Chang K-H. MR imaging findings of intracranial dural arteriovenous fistulas: relations with venous drainage patterns. AJNR Am J Neuroradiol 2005; 26 (10) 2500-2507
  • 30 Abdalkader M, Ma A, Cohen M, Aliphas A, Sakai O, Nguyen TN. Endovascular coiling of large mastoid emissary vein causing pulsatile tinnitus. Interv Neuroradiol 2020; 26 (06) 821-825
  • 31 Foo SY, Swaminathan SK, Krings T. Dilated MMA sign in cDAVF and other arterial feeders on 3D TOF MRA. Neuroradiol J 2022; 35 (03) 290-299
  • 32 Klein P, Shu L, Nguyen TN. et al; ACTION-CVT Study Group. Outcome prediction in cerebral venous thrombosis: the IN-REvASC Score. J Stroke 2022; 24 (03) 404-416
  • 33 Siegler JE, Shu L, Yaghi S. et al; ACTION-CVT Investigators. Endovascular therapy for cerebral vein thrombosis: a propensity-matched analysis of anticoagulation in the treatment of cerebral venous thrombosis. Neurosurgery 2022; 91 (05) 749-755
  • 34 Siegler JE, Klein P, Yaghi S. et al. Cerebral vein thrombosis with vaccine-induced immune thrombotic thrombocytopenia. Stroke 2021; 52 (09) 3045-3053
  • 35 Cohen SD, Goins JL, Butler SG, Morris PP, Browne JD. Dural arteriovenous fistula: diagnosis, treatment, and outcomes. Laryngoscope 2009; 119 (02) 293-297
  • 36 Azuma M, Hirai T, Shigematsu Y. et al. Evaluation of intracranial dural arteriovenous fistulas: comparison of unenhanced 3T 3D time-of-flight MR angiography with digital subtraction angiography. Magn Reson Med Sci 2015; 14 (04) 285-293
  • 37 Willems PWA, Brouwer PA, Barfett JJ, terBrugge KG, Krings T. Detection and classification of cranial dural arteriovenous fistulas using 4D-CT angiography: initial experience. AJNR Am J Neuroradiol 2011; 32 (01) 49-53
  • 38 Meckel S, Maier M, Ruiz DS. et al. MR angiography of dural arteriovenous fistulas: diagnosis and follow-up after treatment using a time-resolved 3D contrast-enhanced technique. AJNR Am J Neuroradiol 2007; 28 (05) 877-884
  • 39 Pekkola J, Kangasniemi M. Posterior fossa dural arteriovenous fistulas: diagnosis and follow-up with time-resolved imaging of contrast kinetics (TRICKS) at 1.5T. Acta Radiol 2011; 52 (04) 442-447
  • 40 Cognard C, Gobin YP, Pierot L. et al. Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995; 194 (03) 671-680
  • 41 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 (02) 166-179
  • 42 Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 1985; 62 (02) 248-256
  • 43 Henderson AD, Miller NR. Carotid-cavernous fistula: current concepts in aetiology, investigation, and management. Eye (Lond) 2018; 32 (02) 164-172
  • 44 Luciani A, Houdart E, Mounayer C, Saint Maurice JP, Merland JJ. Spontaneous closure of dural arteriovenous fistulas: report of three cases and review of the literature. AJNR Am J Neuroradiol 2001; 22 (05) 992-996
  • 45 Naragum V, Barest G, AbdalKader M, Cronk KM, Nguyen TN. Spontaneous Resolution of Post-Traumatic Direct Carotid-Cavernous Fistula. Interv Neurol 2018; 7 (1-2): 1-5
  • 46 Satomi J, van Dijk JMC, 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 (04) 767-770
  • 47 Bhatia KD, Lee H, Kortman H. et al. Endovascular management of intracranial dural AVFs: principles. AJNR Am J Neuroradiol 2022; 43 (02) 160-166
  • 48 Davies MA, Saleh J, ter Brugge K, Willinsky R, Wallace MC. The natural history and management of intracranial dural arteriovenous fistulae: Part 1: Benign lesions. Interv Neuroradiol 1997; 3 (04) 295-302
  • 49 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 (05) 1233-1236
  • 50 Duffau H, Lopes M, Janosevic V. et al. Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature. J Neurosurg 1999; 90 (01) 78-84
  • 51 Eskey CJ, Meyers PM, Nguyen TN. et al; American Heart Association Council on Cardiovascular Radiology and Intervention and Stroke Council. Indications for the performance of intracranial endovascular neurointerventional procedures: a scientific statement from the American Heart Association. Circulation 2018; 137 (21) e661-e689
  • 52 Abdalkader M, Hui F, Amans MR, Raz E, Hanning U, Ma A, Brinjikji W, Malek AM, Oxley TJ, Nguyen TN. Cerebral venous disorders: Diagnosis and endovascular management. J Neuroradiol 2023; DOI: 10.1016/j.neurad.2023.06.002.
  • 53 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 (01) 50-58