Dural Arteriovenous Fistula: Diagnosis, Treatment, and Outcomes

Objectives: The objective of this study is to determine the sensitivity of computed tomography angiography (CTA) and magnetic resonance angiography (MRA) compared to the gold standard, conventional carotid angiography, in the diagnosis of a dural arteriovenous fistula (DAVF). Further objectives include identifying outcomes of treatment and complications as a function of pretreatment radiologic classification. Study Design: This is a retrospective review of adults diagnosed with a DAVE between 1990 and 2006. Methods: Data collected included age, gender, presenting clinical symptoms, diagnostic imaging modalities (conventional angiography, CTA, and/or MRA), interventions (self-compression of artery, embolization, craniotomy, or a combination of these), results (symptoms resolved, improved, or same), and complications (embolic or surgical). All DAVFs were classified according to the Cognard classification. Results: There were a total of 46 patients with 51 fistulas, of whom 42 patients (46 fistulas) had complete follow-up data. Using conventional angiography as the gold standard, CTA had a sensitivity of 15.4%, whereas MRA had a sensitivity of 50%. Embolization (either single or multiple treatments) was the most common treatment, being done in 36/46 (78%) fistulas. Presenting symptoms were resolved or improved in 45/46 fistulas (97.8%) regardless of treatment or Cognard classification. There were complications in 12/46 (26%) patients, most of which were transient and resolved without permanent sequelae. Conclusions: A DAVF is a vascular lesion that is best diagnosed with conventional angiography, but can often be found with MRA. Treatment with endovascular embolization is effective and has few significant complications.