Dural arteriovenous fistulas (dAVFs) are abnormal connections between an artery and a vein in the tough covering over the brain or spinal cord (dura mater). dAVFs involving the larger brain vessels usually arise from progressive narrowing or blockage of one of the brain’s venous sinuses, which route circulated blood from the brain back to the heart. These lesions are usually spontaneous, but are often associated with trauma, surgery, tumors, or blood clot in a venous sinus, or infections near the lesions. These
Symptoms can vary from having no symptoms to “ringing” or “humming” in the ear to fatal bleeding into the brain.
Other symptoms may include:
- Headache
- Visual impairment
- Papilledema (swelling of the optic nerve)
- Seizures
- Hemorrhage
If you or your loved one are diagnosed with an dAVF, your doctor will conduct a thorough evaluation of your symptoms, current/past medical problems, medications, and family history. There are several gold standard diagnostic tests that are available to help provide more information about the aneurysm. These tests also help determine the best course of treatment.
- Computerized Tomography (CT): Non-invasive x-ray to look at the structures within the brain and to determine if the dAVF bled.
- Computerized Tomography angiography: Similar to a CT scan in which contrast is used to have a better view of the brain vessels.
- Magnetic resonance imaging (MRI): medical imaging technique that uses a magnetic field and computer generated radio waves to create detailed images of the brain
- Intracerebral angiogram: a dye test to help analyze arteries and identify the degree of narrowing or obstruction of the artery or blood vessel in the brain
Treatment:
Treatment for dAVFs are individually tailored to each patient.
However, most dAVFs can be treated with endovascular embolization.
Endovascular embolization
This is a minimally invasive procedure that utilizes small catheters to deliver glue or other obstructive materials into the dAVF in hopes that the dAVF will no longer receive blood flow and will eventually die. The surgeon will place a small incision in the groin or radial artery and a catheter is guided by computerized imaging to the dAVF. The occluding material or glue is passed through the dAVF. One advantage of this procedure is that it is less invasive than surgery and can be used for inoperable or deep dAVFs. There is a risk for embolic stroke from the catheter as well as a risk for rebleeding because the AVM may not be completely gone. Multiple treatments may be indicate
Stereotactic radiosurgery
In stereotactic radiosurgery, your doctor uses precisely focused radiation to block the abnormal connection in the blood vessels.
Surgery
Your surgeon may perform surgery to disconnect the dAVF.