Cerebral Dural Arteriovenous Fistulas

Dural arteriovenous fistulas are contained within the dural leaflets, making them a unique arteriovenous shunt of the central nervous system. Those without cortical venous drainage may be found incidentally or in a workup of pulsatile tinnitus or ocular symptoms. These symptoms may also occur in the setting of cortical venous drainage, but additionally, seizures, neurological deficits, or even frank hemorrhage may occur because of disruption of normal parenchymal venous outflow and resultant venous hypertension. In the setting of debilitating symptomatology or cortical venous drainage, management is most often via endovascular therapy via transarterial or transvenous access to the fistulous site and subsequent obliteration. Surgical disconnection and radiosurgical obliteration are excellent alternative treatment options for appropriately selected lesions as well. In this article, background demographic and natural history data as well as treatment approaches are reviewed.