Summary
Awareness of a potential arteriovenous fistula is critical for diagnosis of cranial as well as spinal fistulas. The natural history of cranial and spinal dural arteriovenous fistulas has been clarified during the last decade and interdisciplinary therapies have experienced a substantial development recently. The classification of Cognard & Merland is now the most widely accepted one for cranial dural AVF. It is based on the degree of flow reversal in the sinuses and cortical veins and reflects well the natural history of the different lesions and serves as basis for therapeutic indications. Several studies have defined the annual bleeding risk of cranial dural fistulas between 1.8 and 15%, depending on the pattern of venous drainage and initial symptomatology. Surgical, endovascular and radiosurgical methods must be selectively chosen for the treatment. The risk associated with surgical or endovascular treatment of benign fistulas is higher than the risk of eliminating fistulas that have already led to cortical venous reflux. Transvenous endovascular occlusion or surgical disconnection of draining veins is the treatment of first choice for cranial and spinal dAVF with venous flow reversal. Benign cranial dural arteriovenous fistulas are a developing indication for radiosurgery.
Access provided by Autonomous University of Puebla. Download to read the full chapter text
Chapter PDF
Similar content being viewed by others
References
Awad IA, Little JR, Akarawi WP, Ahl J (1990) Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72: 839–850
Barrow DL, Spector RH, Braun IF, Landman JA, Tindall SC, Tindall GT (1985) Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg 62: 248–256
Brown RD Jr, Wiebers DO, Nichols DA (1994) Intracranial dural arteriovenous fistulae: angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients. J Neurosurg 81: 531–538
Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, Chiras J, Merland JJ (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194: 671–680
Collice M, D'Aliberti G, Talamonti G, Branca V, Boccardi E, Scialfa G, Versari PP (1996) Surgical interruption of leptomeningeal drainage as treatment for intracranial dural arteriovenous fistulas without dural sinus drainage. J Neurosurg 84: 810–817
Davies MA, TerBrugge K, Willinsky R, Coyne T, Saleh J, Wallace MC (1996) The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 85: 830–837
Duffau H, Lopes M, Janosevic V, Sichez JP, Faillot T, Capelle L, Ismail M, Bitar A, Arthuis F, Fohanno D (1999) Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature. Review. J Neurosurg 90: 78–84
Friedman JA, Meyer FB, Nichols DA, Coffey RJ, Hopkins LN, Maher CO, Meissner ID, Pollock BE (2001) Fatal progression of posttraumatic dural arteriovenous fistulas refractory to multimodal therapy. Case report. J Neurosurg 94: 831–835
Friedman JA, Pollock BE, Nichols DA, Gorman DA, Foote RL, Stafford SL (2001) Results of combined stereotactic radiosurgery and transarterial embolization for dural arteriovenous fistulas of the transverse and sigmoid sinuses. J Neurosurg 94: 886–891
Guo WY, Pan DH, Wu HM, Chung WY, Shiau CY, Wang LW, Chiou HJ, Yen MY, Teng MM (1998) Radiosurgery as a treatment alternative for dural arteriovenous fistulas of the cavernous sinus. AJNR Am J Neuroradiol 19: 1081–1087
Halbach V, Higashida RT, Hieshima GB, Mehringer CM, Hardin CW (1989) Transvenous embolization of dural fistulas Dural arteriovenous fistula 121 involving the transverse and sigmoid sinuses. AJNR Am J Neuroradiol 10: 385–392##
Hoh BL, Choudhri TF, Connolly ES Jr, Solomon RA (1998) Surgical management of high-grade intracranial dural arteriovenous fistulas: leptomeningeal venous disruption without nidus excision. Neurosurgery 42: 796–805
Lewis AI, Tomsick TA, Tew JM Jr (1994) Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery. J Neurosurg 81: 851–859
Link MJ, Coffey RJ, Nichols DA, Gorman DA (1996) The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas. J Neurosurg 84: 804–809
Lucas CP, Zabramski JM, Spetzler RF, Jacobowitz R (1997) Treatment for intracranial dural arteriovenous malformations: a meta-analysis from the English language literature. Neurosurgery 40: 1119–1132
Mironov A (1994) Pathogenetical consideration of spontaneous dural arteriovenous fistulas (DAVFs). Acta Neurochir (Wien) 131: 45–58
Mironov A (1995) Classification of spontaneous dural arteriovenous fistulas with regard to their pathogenesis. Acta Radiol 36: 582–592
Morgan MK, Marsh WR (1989) Management of spinal dural arteriovenous malformations. J Neurosurg 70: 832–836
Olteanu-Nerbe V, Uhl E, Steiger HJ, Yousry T, Reulen HJ (1997) Dural arteriovenous fistulas including the transverse and sigmoid sinuses: results of treatment in 30 cases. Acta Neurochir (Wien) 139: 307–318
Pan DH, Chung WY, Guo WY, Wu HM, Liu KD, Shiau CY, Wang LW (2002) Stereotactic radiosurgery for the treatment of dural arteriovenous fistulas involving the transverse-sigmoid sinus. J Neurosurg 96: 823–829
Pollock BE, Nichols DA, Garrity JA, Gorman DA, Stafford SL (1999) Stereotactic radiosurgery and particulate embolization for cavernous sinus dural arteriovenous fistulae. Neurosurgery 45: 459–467
Roy D, Raymond J (1997) The role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40: 1133–1144
Satomi J, van Dijk JM, Terbrugge KG, Willinsky RA, Wallace MC (2002) Benign cranial dural arteriovenous fistulas: outcome of conservative management based on the natural history of the lesion. J Neurosurg 97: 767–770
Schmid-Elsaesser R, Steiger HJ, Yousry T, Seelos KC, Reulen HJ (1997) Radical resection of meningiomas and arteriovenous fistulas involving critical dural sinus segments: experience with intraoperative sinus pressure monitoring and elective sinus reconstruction in 10 patients. Neurosurgery 41: 1005–1018
Schmid-Elsaesser R (2002) General considerations and review of the literature. In: Steiger HJ, Schmid-Elsaesser R, Muacevic A, Brückmann H, Wowra B (2002) Neurosurgery of Arteriovenous Malformations and Fistulas. A Multimodal Approch. Springer, Wien New York pp 1–56
Song JK, Gobin YP, Duckwiler GR, Murayama Y, Frazee JG, Martin NA, Vinuela F (2001) N-butyl 2-cyanoacrylate embolization of spinal dural arteriovenous fistulae. AJNR Am J Neuroradiol 22: 40–47
Sundt TM Jr, Piepgras DG (1983) The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg 59: 32–39
Symon L, Kuyama H, Kendall B (1984) Dural arteriovenous malformations of the spine. Clinical features and surgical results in 55 cases. J Neurosurg 60: 238–247
Tacconi L, Lopez-Izquierdo BC, Symon L (1997) Outcome and prognostic factors in the surgical treatment of spinal dural arteriovenous fistulas. A long-term study. Br J Neurosurg 11: 298–305
Thompson BG, Doppman JL, Oldfield EH (1994) Treatment of cranial dural arteriovenous fistulae by interruption of leptomeningeal venous drainage. J Neurosurg 80: 617–623
van Dijk JM, TerBrugge KG, Willinsky RA, Wallace MC (2002) Clinical course of cranial dural arteriovenous fistulas with long-term persistent cortical venous reflux. Stroke 33: 1233–1236
van Dijk JM, TerBrugge KG, Willinsky RA, Wallace MC (2004) Selective disconnection of cortical venous reflux as treatment for cranial dural arteriovenous fistulas. J Neurosurg 101: 31–35
Vinuela FV, Debrun GM, Fox AJ, Kan S (1983) Detachable calibrated-leak balloon for superselective angiography and embolization of dural arteriovenous malformations. J Neurosurg 58: 817–823
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2005 Springer-Verlag
About this paper
Cite this paper
Steiger, HJ., Hänggi, D., Schmid-Elsaesser, R. (2005). Cranial and spinal dural arteriovenous malformations and fistulas: an update. In: Yonekawa, Y., Keller, E., Sakurai, Y., Tsukahara, T. (eds) New Trends of Surgery for Stroke and its Perioperative Management. Acta Neurochirurgica Supplements, vol 94. Springer, Vienna. https://doi.org/10.1007/3-211-27911-3_18
Download citation
DOI: https://doi.org/10.1007/3-211-27911-3_18
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-24338-1
Online ISBN: 978-3-211-27911-3
eBook Packages: MedicineMedicine (R0)