Materiały źródłowe

• #1 Updates in the management of cranial dural arteriovenous fistula | Stroke and Vascular Neurology

  https://svn.bmj.com/content/5/1/50

  Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. […] Endovascular treatment is often the first line of treatment for dAVF. […] For diagnosis, CT and MRI are usually unremarkable in dAVF. […] Dedicated vascular imaging is considered standard for diagnosis of a fistula. […] Cerebral digital subtraction angiography (DSA) is the gold standard imaging modality to detect and best characterise dAVF. […] Endovascular treatment is generally the first-line treatment for dAVF. […] Follow-up angiography is required to confirm long-term occlusion of dAVF and the durability of treatment.

• #2 Dural arteriovenous fistula (DAVF) | STROKE MANUAL

  https://www.stroke-manual.com/dural-arteriovenous-fistula-davf/

  Dural arteriovenous fistula (DAVF) is characterized by abnormal connections (shunts) between an artery and a vein; DAVF typically presents with tinnitus, hemorrhage, or venous hypertension. […] DAVF accounts for 10-15% of vascular malformations and most commonly affects patients aged 40-60 years. […] Most DAVFs are idiopathic; some patients have a history of previous craniotomy, head trauma, or dural sinus thrombosis. […] CT/MRI is more helpful in detecting complications (hemorrhage, venous infarction, edema) but is insufficient for diagnosing DAVF itself; vascular imaging must be added. […] Vascular imaging (CTA/MRA or DSA) often shows multiple feeders without an intervening nidus. […] DSA remains the best method to accurately assess feeding vessels and the presence and extent of retrograde venous drainage.

• #3 Dural arteriovenous fistulas – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dural-arteriovenous-fistulas/symptoms-causes/syc-20364280

  Dural arteriovenous fistulas (dAVFs) are irregular connections between arteries and veins. […] Treatment for dAVF usually involves an endovascular procedure or stereotactic radiosurgery to block the blood flow to the dAVF. Or surgery may be needed to disconnect or remove the dAVF. […] Most dural arteriovenous fistulas (dAVFs) have no clear origin. But some result from a traumatic head injury, infection, previous brain surgery, blood clots in deep veins or tumors. […] Most experts think that dAVFs involving larger brain veins occur from the narrowing or blockage of one of the brain’s venous sinuses. The venous sinuses are channels in the brain that route circulated blood from the brain back to the heart.

• #4 Dural arteriovenous fistulas – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dural-arteriovenous-fistulas/diagnosis-treatment/drc-20364281

  A Mayo Clinic neurologist converses with a woman about her diagnosis. […] If you have symptoms of a dural arteriovenous fistula (dAVF), you may need imaging tests. […] CT scans. These tests can show fluid buildup caused by increased blood pressure in the brain. They also can show bleeding that may be caused by a dAVF. […] MRIs. MRI images can reveal the shape of a dAVF. An MRI also can detect very small bleeds. The test may determine the impact of any irregular blood vessel structures. […] Angiography. Catheter-based cerebral angiography, also known as digital subtraction angiography, is the most reliable tool to diagnose dAVF. It’s essential for defining: […] How many fistulae exist and where. […] Anatomy of the external carotid arteries and any branches between them and the dura. Carotid arteries deliver blood to the brain and head. […] Fistula blood vessels’ structure. […] Whether cardiovascular disease also is present. […] How much narrowing or blockage has occurred in the dural sinus. […] Whether any affected veins are dilated and to what extent.

• #5 Dural Arteriovenous Fistulae | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/dural-arteriovenous-fistulae

  The following tests may be used to diagnose your dural arteriovenous fistulae (DAVF) and help identify its size, location and blood-flow pattern. […] Cerebral angiography. This X-ray exam shows the structure of blood vessels and is the most important test in diagnosing DAVF. A harmless dye, visible on X-rays, is injected into an artery that supplies blood to the brain. As the dye flows through blood vessels to the brain, it will show any obstructions or leaks. […] Computed tomography (CT) scan. During this test, X-ray beams are used to create a 3-D image of the brain and may help identify any bleeding or hemorrhage. For more precise images of blood vessels, the cerebral angiography and magnetic resonance angiography (MRA) are performed. […] Magnetic resonance angiography (MRA). An MRA uses magnetic resonance imaging to create detailed images of blood vessels. Using a strong magnetic field, it generates a 3-D image of the brain to detect, diagnose and aid the treatment of DAVFs and other vascular disorders. In some cases, a dye is injected intravenously.

• #6 Dural arteriovenous fistulas – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dural-arteriovenous-fistulas/diagnosis-treatment/drc-20364281

  A Mayo Clinic neurologist converses with a woman about her diagnosis. […] If you have symptoms of a dural arteriovenous fistula (dAVF), you may need imaging tests. […] CT scans. These tests can show fluid buildup caused by increased blood pressure in the brain. They also can show bleeding that may be caused by a dAVF. […] MRIs. MRI images can reveal the shape of a dAVF. An MRI also can detect very small bleeds. The test may determine the impact of any irregular blood vessel structures. […] Angiography. Catheter-based cerebral angiography, also known as digital subtraction angiography, is the most reliable tool to diagnose dAVF. It’s essential for defining: […] How many fistulae exist and where. […] Anatomy of the external carotid arteries and any branches between them and the dura. Carotid arteries deliver blood to the brain and head. […] Fistula blood vessels’ structure. […] Whether cardiovascular disease also is present. […] How much narrowing or blockage has occurred in the dural sinus. […] Whether any affected veins are dilated and to what extent.

• #7 Dural Arteriovenous Fistulae | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/dural-arteriovenous-fistulae

  The following tests may be used to diagnose your dural arteriovenous fistulae (DAVF) and help identify its size, location and blood-flow pattern. […] Cerebral angiography. This X-ray exam shows the structure of blood vessels and is the most important test in diagnosing DAVF. A harmless dye, visible on X-rays, is injected into an artery that supplies blood to the brain. As the dye flows through blood vessels to the brain, it will show any obstructions or leaks. […] Computed tomography (CT) scan. During this test, X-ray beams are used to create a 3-D image of the brain and may help identify any bleeding or hemorrhage. For more precise images of blood vessels, the cerebral angiography and magnetic resonance angiography (MRA) are performed. […] Magnetic resonance angiography (MRA). An MRA uses magnetic resonance imaging to create detailed images of blood vessels. Using a strong magnetic field, it generates a 3-D image of the brain to detect, diagnose and aid the treatment of DAVFs and other vascular disorders. In some cases, a dye is injected intravenously.

• #8

  https://journals.lww.com/md-journal/fulltext/2023/11100/dural_arteriovenous_fistula_with_progressive.101.aspx

  Dural arteriovenous fistulas (DAVFs) are rare cerebral abnormal arteriovenous anastomoses. It is uncommon for DAVFs with parkinsonism and dementia, so it is easily misdiagnosed. Neuroimaging examinations show that multifocal DAVFs are related to venous thrombosis and white matter changes, suggesting that cerebral circulatory disorders caused by venous hypertensive encephalopathy lead to dementia in patients. Digital subtraction angiography confirmed the diagnosis and subsequent treatment of DAVFs. […] They were diagnosed with dural arteriovenous fistulas by digital subtraction angiography. […] There are few reports of progressive dementia and parkinsonism in DAVF patients, and neurologists should be vigilant to avoid misdiagnosing DAVF. […] At present, brain and enhanced CT scans are not able provide data that can lead to a definitive diagnosis of DAVF but can show secondary manifestations, such as vasodilation, cerebral hemorrhage, hydrocephalus, cerebral edema, and calcification.

• #9 Diagnosis and treatment of a dural arteriovenous fistula presenting with progressive parkinsonism and dementia: A case report and literature review

  https://www.spandidos-publications.com/10.3892/etm.2014.2122

  A dural arteriovenous fistula (DAVF) presenting with parkinsonism and dementia is rare; thus, is easily misdiagnosed. […] In conclusion, progressive parkinsonism and dementia with an abnormal flow void shadow on cranial MRI films should be considered as a possible diagnosis of a DAVF. […] Due to varying nonspecific clinical manifestations, the diagnosis of a DAVF is often based on imaging studies. […] Diagnosis is difficult using cranial CT; however, this imaging technique can reveal certain secondary changes caused by a DAVF, including venous sinus thrombosis, acute and sub-acute subarachnoid hemorrhage and subdural or cerebral hemorrhage. […] However, cranial MRI is better compared with CT for the detection of DAVF-induced secondary changes, and is useful to show the extensive flow void phenomenon.

• #10 Intracranial Hemorrhage from Dural Arteriovenous Fistulas: What Can We Find with CT Angiography?

  https://www.mdpi.com/2379-139X/7/4/68

  Dural arteriovenous fistulas (DAVF) represent a rare acquired intracranial vascular malformation, with a variety of clinical signs and symptoms, which make their diagnosis difficult. […] In this paper the authors’ goal was to verify the accuracy and utility of contrast-enhanced brain CT angiography (CTA) for the identification and the characterization of dural arteriovenous fistulas (DAVFs) in patients who presented with brain hemorrhage compared to 3D digital subtraction angiography (3D DSA); […] conclusions: CTA can represent a valid alternative diagnostic method to 3D DSA for the study of DAVF in the initial and preliminary diagnostic approach, especially in emergency situations. […] In fact, it represents a fast, inexpensive, non-invasive and above all, easily accessible and available diagnostic technique, unlike DSA or MRI, allowing to provide information necessary for the identification, classification and treatment planning of DAVFs.

• #11 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532274/

  Dural arteriovenous fistulas, sometimes referred to as dural arteriovenous malformations, are vascular abnormalities in which arteries arising from branches of the carotid or vertebral arteries drain directly into the dural leaflets of the venous sinuses. […] This activity outlines how to properly evaluate dural arteriovenous fistulas, and highlights the role of the interprofessional team in caring for patients with this condition. […] The Borden and Cognard classifications are the most well-known classification systems used for predicting the aggressiveness of dAVFs. […] Imaging studies in which dAVFs may be identified are computed tomography angiography (CTA) or magnetic resonance angiography (MRA), demonstrating dilated tortuous vessels corresponding to abnormal arteries and veins, sinus enlargement, or sinus occlusion.

• #12 Dural Arteriovenous Fistulas Treatment

  https://www.rwjbh.org/treatment-care/neuroscience/neurosurgery/conditions-treated/dural-arteriovenous-fistulas/

  During a physical and neurological exam, your doctor may recommend diagnostic tests to determine if you have a dAVF. […] Initial evaluation for dAVF usually involves cross-sectional imaging tests of the head, such as a magnetic resonance imaging (MRI) scan. […] Imaging tests used to diagnose dAVF include: […] MRI scan: This is the gold standard for diagnosis of a dAVF, as it can establish its shape and the extent of the condition. […] Once your neurologist has administered the imaging tests and has located the vascular malformation, they will order a catheter-based cerebral angiography to make a definitive diagnosis of a dAVF.

• #13 Intracranial Hemorrhage from Dural Arteriovenous Fistulas: What Can We Find with CT Angiography?

  https://www.mdpi.com/2379-139X/7/4/68

  The initial radiological evaluation is essentially based on cross-sectional non-contrast computed tomography (CT) and magnetic resonance imaging (MRI) studies. However, non-contrast computed tomography (CT) and conventional magnetic resonance imaging (MR) show often irrelevant diagnostic accuracy with benign DAVF. […] Brain CT angio studies allowed the identification of the fistula in 16/26 (61%) patients, with a diagnostic sensibility of 61%, a diagnostic specificity of 100% and a diagnostic accuracy of 92 %. […] The CTA shows a number of direct and indirect signs that suggest intracranial DAVF. These signs can be used to screen for DAVF in ICH patients. […] In particular, such as in our series, when we find the presence of numerous and engorged cortical veins and asymmetric attenuation of venous sinus with a brain CT angio exam, we can suspect the presence of DAVF with a high probability, mostly in a patient with an atypical ICH. […] However, its sensitivity is reduced compared to 3D DSA, especially in identifying small or low-flow fistulas.

• #14 Intracranial Hemorrhage from Dural Arteriovenous Fistulas: What Can We Find with CT Angiography?

  https://www.mdpi.com/2379-139X/7/4/68

  Dural arteriovenous fistulas (DAVF) represent a rare acquired intracranial vascular malformation, with a variety of clinical signs and symptoms, which make their diagnosis difficult. […] In this paper the authors’ goal was to verify the accuracy and utility of contrast-enhanced brain CT angiography (CTA) for the identification and the characterization of dural arteriovenous fistulas (DAVFs) in patients who presented with brain hemorrhage compared to 3D digital subtraction angiography (3D DSA); […] conclusions: CTA can represent a valid alternative diagnostic method to 3D DSA for the study of DAVF in the initial and preliminary diagnostic approach, especially in emergency situations. […] In fact, it represents a fast, inexpensive, non-invasive and above all, easily accessible and available diagnostic technique, unlike DSA or MRI, allowing to provide information necessary for the identification, classification and treatment planning of DAVFs.

• #15 Dural arteriovenous fistulas – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dural-arteriovenous-fistulas/diagnosis-treatment/drc-20364281

  A Mayo Clinic neurologist converses with a woman about her diagnosis. […] If you have symptoms of a dural arteriovenous fistula (dAVF), you may need imaging tests. […] CT scans. These tests can show fluid buildup caused by increased blood pressure in the brain. They also can show bleeding that may be caused by a dAVF. […] MRIs. MRI images can reveal the shape of a dAVF. An MRI also can detect very small bleeds. The test may determine the impact of any irregular blood vessel structures. […] Angiography. Catheter-based cerebral angiography, also known as digital subtraction angiography, is the most reliable tool to diagnose dAVF. It’s essential for defining: […] How many fistulae exist and where. […] Anatomy of the external carotid arteries and any branches between them and the dura. Carotid arteries deliver blood to the brain and head. […] Fistula blood vessels’ structure. […] Whether cardiovascular disease also is present. […] How much narrowing or blockage has occurred in the dural sinus. […] Whether any affected veins are dilated and to what extent.

• #16 Dural arteriovenous fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/dural-arteriovenous-fistula?lang=us

  Dural arteriovenous fistulas (dAVF) are a heterogeneous collection of conditions that share arteriovenous shunts from dural vessels. They present variably with hemorrhage or venous hypertension and can be challenging to treat. […] Diagnosis can be difficult on non-contrast CT but should be thought of when an intracranial hemorrhage is in an unusual location or age group. With contrast, particularly with CT angiography, a diagnosis can often be made if care is taken. […] On routine non-vascular imaging, the diagnosis can be difficult in patients without retrograde leptomeningeal venous drainage although sometimes enlarged arterial feeders or dilated pial vessels in the subarachnoid space, best seen on T2 weighted imaging, can be a clue to the diagnosis. […] Catheter digital subtraction angiography demonstrates arteriovenous shunting most typically with multiple feeders and with no intervening nidus. DSA remains the gold standard in both diagnosis and accurate classification of dural arteriovenous fistulas, allowing not only systematic evaluation of feeding vessels (and thus planning for potential intervention), but also demonstrating the presence and extent of retrograde leptomeningeal venous drainage.

• #17 Spinal dural arteriovenous fistula: a case series and review of imaging findings | Spinal Cord Series and Cases

  https://www.nature.com/articles/scsandc201724

  Spinal dural arteriovenous fistulae (sdAVF) are rare lesions. […] On spinal magnetic resonance imaging (MRI), multisegmental T2 hyperintensities along with associated flow voids are pathognomonic of sdAVF. […] Definitive diagnosis and localization is achieved with complete spinal angiography. […] The fundamental component to diagnosing sdAVF is understanding the radiological features found on MRI and spinal angiography. […] Although T1 weighted MRI is variable and non-specific, multisegmental spinal cord hyperintensity on T2-weighted images with associated subarachnoid flow voids are pathognomonic of the condition. Spinal angiography confirms and localizes the fistula allowing for definitive management. […] All patients eventually had an MRI showing typical features of sdAVF: long multisegment central cord T2 hyperintensities dorsal subarachnoid flow voids.

• #18

  https://link.springer.com/article/10.1007/s00415-021-10571-0

  The clinical, CSF, MRI and angiographic findings are summarised in Table 1. […] Steroids were administered more frequently for presumed ATM with Cognard type V DAVF (5/6) compared to spinal (1/27, cervical) DAVF. […] Acute or hyperacute deterioration was observed in 4/6 cases. […] Clinical deterioration after steroid treatment occurred in 4/5 cases. […] The following features may suggest DAVF rather than myelitis: older male patients (6/6), symptomatic progression over 4 or more weeks (6/6) and acellular CSF (5/5). […] Importantly, steroids can cause dramatic clinical deterioration of DAVF, probably through transient mineralocorticoid-induced hypervolemia and venous hypertension. […] The diagnosis of DAVF usually rests on standard MRI, can be guided by MR angiography (MRA) and is confirmed by digital subtraction angiography (DSA).

• #19 Dural Arteriovenous Fistulas Treatment

  https://www.rwjbh.org/treatment-care/neuroscience/neurosurgery/conditions-treated/dural-arteriovenous-fistulas/

  During a physical and neurological exam, your doctor may recommend diagnostic tests to determine if you have a dAVF. […] Initial evaluation for dAVF usually involves cross-sectional imaging tests of the head, such as a magnetic resonance imaging (MRI) scan. […] Imaging tests used to diagnose dAVF include: […] MRI scan: This is the gold standard for diagnosis of a dAVF, as it can establish its shape and the extent of the condition. […] Once your neurologist has administered the imaging tests and has located the vascular malformation, they will order a catheter-based cerebral angiography to make a definitive diagnosis of a dAVF.

• #20

  https://link.springer.com/article/10.1007/s00415-021-10571-0

  The clinical, CSF, MRI and angiographic findings are summarised in Table 1. […] Steroids were administered more frequently for presumed ATM with Cognard type V DAVF (5/6) compared to spinal (1/27, cervical) DAVF. […] Acute or hyperacute deterioration was observed in 4/6 cases. […] Clinical deterioration after steroid treatment occurred in 4/5 cases. […] The following features may suggest DAVF rather than myelitis: older male patients (6/6), symptomatic progression over 4 or more weeks (6/6) and acellular CSF (5/5). […] Importantly, steroids can cause dramatic clinical deterioration of DAVF, probably through transient mineralocorticoid-induced hypervolemia and venous hypertension. […] The diagnosis of DAVF usually rests on standard MRI, can be guided by MR angiography (MRA) and is confirmed by digital subtraction angiography (DSA).

• #21 Dural Arteriovenous Fistulae | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/dural-arteriovenous-fistulae

  The following tests may be used to diagnose your dural arteriovenous fistulae (DAVF) and help identify its size, location and blood-flow pattern. […] Cerebral angiography. This X-ray exam shows the structure of blood vessels and is the most important test in diagnosing DAVF. A harmless dye, visible on X-rays, is injected into an artery that supplies blood to the brain. As the dye flows through blood vessels to the brain, it will show any obstructions or leaks. […] Computed tomography (CT) scan. During this test, X-ray beams are used to create a 3-D image of the brain and may help identify any bleeding or hemorrhage. For more precise images of blood vessels, the cerebral angiography and magnetic resonance angiography (MRA) are performed. […] Magnetic resonance angiography (MRA). An MRA uses magnetic resonance imaging to create detailed images of blood vessels. Using a strong magnetic field, it generates a 3-D image of the brain to detect, diagnose and aid the treatment of DAVFs and other vascular disorders. In some cases, a dye is injected intravenously.

• #22 Cranial Dural Arteriovenous Fistula: Diagnosis and Classification with Time-Resolved MR Angiography at 3T | American Journal of Neuroradiology

  https://www.ajnr.org/content/30/8/1546

  The diagnosis of dural arteriovenous fistula (DAVF) remains one of the few uncontested indications for catheter based cerebral angiography. […] We report our experience of using a commercially available form of time-resolved MR angiography (trMRA) at 3T for the diagnosis and classification of a cranial DAVF compared with the reference standard of digital subtraction angiography (DSA). […] The reported result of the DSA was used as the gold standard against which the performance of the trMRA was measured. […] In 93% (39/42) of DAVF cases, the 3 readers were unanimous and correct in their independent interpretation of the trMRA, correctly identifying (or excluding) all fistulas and accurately classifying them when encountered. […] In this small series, trMRA at 3T seems be a reliable technique in the screening and surveillance of DAVF in specific clinical situations.

• #23 Cranial Dural Arteriovenous Fistula: Diagnosis and Classification with Time-Resolved MR Angiography at 3T | American Journal of Neuroradiology

  https://www.ajnr.org/content/30/8/1546

  The diagnosis of a cranial dural arteriovenous fistula (DAVF) has traditionally been made with catheter-based cerebral intra-arterial digital subtraction angiography (DSA). […] Although the diagnosis of DAVF may commonly be suspected on planar CT and MR imaging, DSA, with its high spatial and temporal resolution, has been required to confirm the diagnosis and define the lesion. […] We report here our experience with using a technique of whole-head, trMRA at 3T for the diagnosis and classification of DAVF compared with the reference standard of DSA. […] The reported result of the DSA examination regarding the presence, location, and classification of the fistula was used as the criterion standard against which the performance of the trMRA was compared. […] The consensus opinion among the readers with use of this form of trMRA (vs DSA as the criterion standard) was 100% sensitive and 100% specific, not only for DAVF identification but for correct grading of the fistula.

• #24 Cranial Dural Arteriovenous Fistula: Diagnosis and Classification with Time-Resolved MR Angiography at 3T

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7051603/

  The diagnosis of dural arteriovenous fistula (DAVF) remains one of the few uncontested indications for catheter based cerebral angiography. We report our experience of using a commercially available form of time-resolved MR angiography (trMRA) at 3T for the diagnosis and classification of a cranial DAVF compared with the reference standard of digital subtraction angiography (DSA). […] The reported result of the DSA was used as the gold standard against which the performance of the trMRA was measured. […] In this small series, trMRA at 3T seems be a reliable technique in the screening and surveillance of DAVF in specific clinical situations. […] The diagnosis of a cranial dural arteriovenous fistula (DAVF) has traditionally been made with catheter-based cerebral intra-arterial digital subtraction angiography (DSA).

• #25 Cranial Dural Arteriovenous Fistula: Diagnosis and Classification with Time-Resolved MR Angiography at 3T

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7051603/

  The characterization of the fistula is based on the presence or absence of cortical venous reflux (CVR), which, in turn, predicts their benign or malignant nature and thus dictates the management of these vascular lesions. […] Our study evaluated the performance of a commercially available form of trMRA optimized for spatial and temporal resolution with whole-head coverage at 3T for the screening and grading of DAVFs in a population of patients in which the prevalence of a fistula was 48% (20/42). […] The consensus opinion among the readers with use of this form of trMRA (vs DSA as the criterion standard) was 100% sensitive and 100% specific, not only for DAVF identification but for correct grading of the fistula. […] This technique of trMRA does not rely on visualization of feeding arteries but, rather, exploits the obligatory early venous filling to identify fistulas.

• #26 Cranial Dural Arteriovenous Fistula: Diagnosis and Classification with Time-Resolved MR Angiography at 3T | American Journal of Neuroradiology

  https://www.ajnr.org/content/30/8/1546

  Our study supports the use of trMRA in the arena of cranial DAVF only for the purposes of screening and surveillance and not as a tool for complete characterization of a fistula. […] This technique of trMRA does not rely on visualization of feeding arteries but, rather, exploits the obligatory early venous filling to identify fistulas.

• #27 Dural arteriovenous fistulas – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dural-arteriovenous-fistulas/diagnosis-treatment/drc-20364281

  A Mayo Clinic neurologist converses with a woman about her diagnosis. […] If you have symptoms of a dural arteriovenous fistula (dAVF), you may need imaging tests. […] CT scans. These tests can show fluid buildup caused by increased blood pressure in the brain. They also can show bleeding that may be caused by a dAVF. […] MRIs. MRI images can reveal the shape of a dAVF. An MRI also can detect very small bleeds. The test may determine the impact of any irregular blood vessel structures. […] Angiography. Catheter-based cerebral angiography, also known as digital subtraction angiography, is the most reliable tool to diagnose dAVF. It’s essential for defining: […] How many fistulae exist and where. […] Anatomy of the external carotid arteries and any branches between them and the dura. Carotid arteries deliver blood to the brain and head. […] Fistula blood vessels’ structure. […] Whether cardiovascular disease also is present. […] How much narrowing or blockage has occurred in the dural sinus. […] Whether any affected veins are dilated and to what extent.

• #28 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532274/

  A six-vessel cerebral digital subtraction angiogram (DSA) is required to establish the diagnosis and plan treatment. […] The decision of whether to treat dAVFs is based on the patient’s symptoms, medical comorbidities, and risk of intracranial hypertension or hemorrhage. […] An integrated approach with a team of healthcare professionals is recommended to make an early diagnosis and appropriate treatment.

• #29 Dural arteriovenous fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/dural-arteriovenous-fistula?lang=us

  Dural arteriovenous fistulas (dAVF) are a heterogeneous collection of conditions that share arteriovenous shunts from dural vessels. They present variably with hemorrhage or venous hypertension and can be challenging to treat. […] Diagnosis can be difficult on non-contrast CT but should be thought of when an intracranial hemorrhage is in an unusual location or age group. With contrast, particularly with CT angiography, a diagnosis can often be made if care is taken. […] On routine non-vascular imaging, the diagnosis can be difficult in patients without retrograde leptomeningeal venous drainage although sometimes enlarged arterial feeders or dilated pial vessels in the subarachnoid space, best seen on T2 weighted imaging, can be a clue to the diagnosis. […] Catheter digital subtraction angiography demonstrates arteriovenous shunting most typically with multiple feeders and with no intervening nidus. DSA remains the gold standard in both diagnosis and accurate classification of dural arteriovenous fistulas, allowing not only systematic evaluation of feeding vessels (and thus planning for potential intervention), but also demonstrating the presence and extent of retrograde leptomeningeal venous drainage.

• #30 Dural Arteriovenous Fistula Presenting As Pulsatile Tinnitus | Journal of the Belgian Society of Radiology

  https://jbsr.be/articles/10.5334/jbsr.2619

  We report magnetic resonance imaging characteristics of a dural arteriovenous fistula (dAVF), a possible cause of pulsatile tinnitus. […] If a dAVF is suspected, MRA without contrast enhancement should be performed, with TOF images being the most valuable sequence. In case of an inconclusive examination, or for extensive investigation of hemodynamics, selective angiography is necessary, which remains the gold standard. […] MR(A) findings of a dAVF include one or more widened, tortuous feeding arteries with strong collateralisation, widened transosseous vessels and flow voids in the involved dural sinuses. […] RCVD is the key feature to classify and treat dAVFs (Cognard classification). The presence of RCVD is associated with an increased risk of intracranial bleeding. When RCVD is absent (Cognard I and IIa), a wait-and-see policy is possible. In case of high-grade dAVFs (Cognard IIb-V), treatment is necessary.

• #31 Updates in the management of cranial dural arteriovenous fistula | Stroke and Vascular Neurology

  https://svn.bmj.com/content/5/1/50

  Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. […] Endovascular treatment is often the first line of treatment for dAVF. […] For diagnosis, CT and MRI are usually unremarkable in dAVF. […] Dedicated vascular imaging is considered standard for diagnosis of a fistula. […] Cerebral digital subtraction angiography (DSA) is the gold standard imaging modality to detect and best characterise dAVF. […] Endovascular treatment is generally the first-line treatment for dAVF. […] Follow-up angiography is required to confirm long-term occlusion of dAVF and the durability of treatment.

• #32 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532274/

  A six-vessel cerebral digital subtraction angiogram (DSA) is required to establish the diagnosis and plan treatment. […] The decision of whether to treat dAVFs is based on the patient’s symptoms, medical comorbidities, and risk of intracranial hypertension or hemorrhage. […] An integrated approach with a team of healthcare professionals is recommended to make an early diagnosis and appropriate treatment.

• #33 Spinal dural arteriovenous fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/spinal-dural-arteriovenous-fistula?lang=us

  Spinal dural arteriovenous fistulas (SDAVF) are the most common type of spinal vascular malformation, accounting for ~70% of all such lesions. […] The incidence of SDAVF peaks in the 5th and 6th decades and males are more commonly affected than females. […] SDAVFs cause symptoms through venous hypertension and congestion of the cord with edema. The most common clinical presentations are progressive pain, lower extremity weakness or sensory changes. Sphincter dysfunction may also occur. The onset of symptoms is insidious with a slowly progressive course occurring over several years. There is often a significant delay between presentation and diagnosis. […] DSA is the gold standard test for confirming the diagnosis and it provides options for treatment. It is a time consuming and potentially dangerous investigation as dissection of a vessel can potentially lead to cord ischemia. […] Treatment options include endovascular or surgical occlusion of the shunt.

• #34 Spinal Dural Arteriovenous Fistulas | American Journal of Neuroradiology

  http://www.ajnr.org/content/30/4/639

  SUMMARY: Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive para- or tetraplegia. […] Despite being the most commonly encountered spinal vascular malformation, spinal dural arteriovenous fistulas (SDAVFs) are rare and still underdiagnosed entities, which, if not treated properly, can lead to considerable morbidity with progressive spinal cord symptoms. […] Because presenting clinical symptoms are unspecific, the neuroradiologist is often the first clinician to raise the possibility of this diagnosis, which initially rests mainly on MR imaging. […] For a thorough understanding of the disease and for planning the therapeutic strategy, however, selective spinal digital subtraction angiography (DSA) still is necessary.

• #35 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532274/

  Dural arteriovenous fistulas, sometimes referred to as dural arteriovenous malformations, are vascular abnormalities in which arteries arising from branches of the carotid or vertebral arteries drain directly into the dural leaflets of the venous sinuses. […] This activity outlines how to properly evaluate dural arteriovenous fistulas, and highlights the role of the interprofessional team in caring for patients with this condition. […] The Borden and Cognard classifications are the most well-known classification systems used for predicting the aggressiveness of dAVFs. […] Imaging studies in which dAVFs may be identified are computed tomography angiography (CTA) or magnetic resonance angiography (MRA), demonstrating dilated tortuous vessels corresponding to abnormal arteries and veins, sinus enlargement, or sinus occlusion.

• #36 Dural arteriovenous fistula – Wikipedia

  https://en.wikipedia.org/wiki/Dural_arteriovenous_fistula

  Cerebral angiography is the diagnostic standard. MRIs are typically normal but can identify venous hypertension as a result of arterial-venous shunting. […] The Borden Classification of dural arteriovenous malformations or fistulas, groups into three types based upon their venous drainage. […] Type II fistulas need to be treated to prevent hemorrhage. The treatment may involve embolization of the draining sinus as well as clipping or embolization of the draining veins. […] Type III dural AV fistulas drain directly into subarachnoid veins. These veins can form aneurysms and bleed. Type III dural fistulas need to be treated to prevent hemorrhage. Treatment can be as simple as clipping the draining vein at the site of the dural sinus. […] Treatment decisions are more complicated and require a consultation with a multidisciplinary team consisting of at least a interventional neuroradiologist, neurosurgeon and radiotherapist familiar with these lesions.

• #37 Dural arteriovenous fistulas presenting with brainstem dysfunction: diagnosis and surgical treatment in: Neurosurgical Focus Volume 32 Issue 5 (2012) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/32/5/2012.2.focus1217.xml

  A cerebral dural arteriovenous fistula (DAVF) is an acquired abnormal arterial-to-venous connection within the leaves of the intracranial dura with a wide range of clinical presentations and natural history. […] The Cognard classification correlates venous drainage patterns with neurological course, identifying 5 DAVF types with increasing rates of symptomatic presentation. […] In this paper the authors present 2 patients presenting initially with brainstem dysfunction rather than myelopathy secondary to craniocervical DAVF. […] A spinal DAVF occurs when a radicular artery makes a direct anomalous shunt with a radicular vein within the dural leaflets of the nerve root sleeve. […] A cervical DAVF is a rare entity; the majority of spinal DAVFs present as thoracolumbar lesions with myelopathy.

• #38 Dural arteriovenous fistulas presenting with brainstem dysfunction: diagnosis and surgical treatment in: Neurosurgical Focus Volume 32 Issue 5 (2012) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/32/5/2012.2.focus1217.xml

  In this paper we present 2 patients with brainstem dysfunction secondary to DAVF. […] Our literature search followed by a secondary review of the associated references in the primary sources revealed only 4 reported Cognard Type V DAVFs presenting as brainstem ischemia in the English literature, with a fifth case in the Japanese literature. […] Our report emphasizes the need to further evaluate brainstem stroke of unknown origin through more comprehensive vascular studies, including cerebral angiograms. […] The primary mechanism responsible for brainstem dysfunction among the patients noted above is believed to be venous hypertension secondary to arterial pressure via the fistula. […] Our 2 cases demonstrate that although previous reports largely relied on endovascular embolization occlusion techniques, open surgical disconnection is feasible, safe, and efficacious for both cerebral and cervical lesions. […] Prompt diagnosis and treatment are important to provide the patient with the best chance at improvement.

• #39 Dural arteriovenous fistula – Wikipedia

  https://en.wikipedia.org/wiki/Dural_arteriovenous_fistula

  Cerebral angiography is the diagnostic standard. MRIs are typically normal but can identify venous hypertension as a result of arterial-venous shunting. […] The Borden Classification of dural arteriovenous malformations or fistulas, groups into three types based upon their venous drainage. […] Type II fistulas need to be treated to prevent hemorrhage. The treatment may involve embolization of the draining sinus as well as clipping or embolization of the draining veins. […] Type III dural AV fistulas drain directly into subarachnoid veins. These veins can form aneurysms and bleed. Type III dural fistulas need to be treated to prevent hemorrhage. Treatment can be as simple as clipping the draining vein at the site of the dural sinus. […] Treatment decisions are more complicated and require a consultation with a multidisciplinary team consisting of at least a interventional neuroradiologist, neurosurgeon and radiotherapist familiar with these lesions.

• #40 Dural arteriovenous fistula (DAVF) | STROKE MANUAL

  https://www.stroke-manual.com/dural-arteriovenous-fistula-davf/

  In a patient presenting with pulsatile tinnitus, ultrasound revealed increased flow in the external carotid artery (ECA) branch, characterized by aliasing and reduced pulsatility. Magnetic resonance angiography (MRA) subsequently confirmed the suspected diagnosis of a dural arteriovenous fistula (DAVF). […] Treatment decision is based on the type of the fistula, patients’ age and comorbidities, and the presence of symptoms attributable to the fistula. […] Endovascular treatment involves occluding the abnormal connection between the artery and vein using embolization techniques. […] DSA reveals a fistula between the superficial temporal artery and the superior sagittal sinus.

• #41 Dural arteriovenous fistula masquerading as pulsatile tinnitus: radiologic assessment and clinical implications | Scientific Reports

  https://www.nature.com/articles/srep36601

  Pulsatile tinnitus (PT) is often an initial presenting symptom of dural arteriovenous fistula (dAVF), but it may be overlooked or diagnosed late if not suspected on initial diagnostic work-up. […] Of 220 patients who were diagnosed with dAVF between 2003 and 2014, 30 (13.6%) presented with only PT as their initial symptom. […] PT is often the sole initial symptom of dAVF, but a high index of suspicion and an appropriate evaluation are essential to avoid misdiagnosis and potentially catastrophic consequences. […] Considering that most dAVFs are curable with presently available treatment modalities, accurate diagnosis of dAVF presenting with only PT by performing a meticulous physical examination and choosing appropriate neuroimaging modalities is essential. […] To sum up, PT was the only initial symptom in more than 10% of dAVF, and the transverse-sigmoid sinus was the most common site of dAVF triggering PT.

• #42 Dural arteriovenous fistulas and headache features: an observational study | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-020-1073-1

  Dural arteriovenous fistulas are intracranial vascular malformations, fed by dural arteries and draining venous sinuses or meningeal veins. Clinical course varies widely and ranges from benign with spontaneous remission to fatal, due to cerebral hemorrhage. […] In particular, ocular symptoms accompanying non-migraine-like headache should be promptly recognized and raise the suspicion of a carotid-cavernous fistula, while migraine-like headache may suggest other dural arteriovenous fistulas. […] The clinical course of DAVFs varies widely and ranges from benign with spontaneous remission to fatal due to cerebral hemorrhage. […] Symptoms depend on DAVF location and the pattern of the venous drainage. In particular, CCFs often present with ocular symptoms, due to the reversal of flow in the ophthalmic veins related to sinus increased pressure.

• #43 Delayed Diagnosis of Spinal Dural Arteriovenous Fistula: A Case Report and Scoping Review

  https://www.mdpi.com/2077-0383/13/3/711

  Spinal dural arteriovenous fistula (SDAVF) is among the most common arterial shunt diseases typically found in middle aged or older men. […] However, the condition is easily misdiagnosed, and it can take some time to arrive at a definitive diagnosis. […] In a previous study, the median time from onset to treatment was longer in misdiagnosed patients than in correctly diagnosed ones (11 vs. 4 months). […] Misdiagnosed patients developed additional disabilities by the time a correct diagnosis was made (Aminoff–Logue gait grade of 3.6 vs. 2.1) and thus achieved significantly smaller improvements after the treatment (Aminoff–Logue gait grade of 3.0 vs. 1.1) compared to those who were correctly diagnosed with spinal DAVFs. […] We found the main cause of delayed or incorrect diagnosis to be the failure to recognize the characteristics of these lesions, clinically and in neuroimaging findings.

• #44 Delayed Diagnosis of Spinal Dural Arteriovenous Fistula: A Case Report and Scoping Review

  https://www.mdpi.com/2077-0383/13/3/711

  The primary reason for delayed and incorrect SDAVF diagnosis is that SDAVF is easily misrepresented as other diseases. […] The initial symptoms of SDAVF are nonspecific motor and sensory deficits affecting the lower extremities. […] SDAVF treatment includes microsurgery and embolization. The treatment goal is to prevent the flow of blood from the proximal intradural vein and fistula. […] Early diagnosis and treatment are therefore essential; results emphasize their importance in SDAVF. […] SDAVF is frequently misdiagnosed due to its nonspecific features, and late diagnosis can worsen the prognosis. Spinal MRI should be conducted in patients presenting symptoms such as slowly progressive lower-limb weakness, paresthesia, and vesicorectal dysfunction. […] Delayed diagnosis of DAVF usually causes long-term irreversible neurological complications. Thus, early diagnosis and intervention are crucial.

• #45 Diagnosis and treatment of a dural arteriovenous fistula presenting with progressive parkinsonism and dementia: A case report and literature review

  https://www.spandidos-publications.com/10.3892/etm.2014.2122

  A dural arteriovenous fistula (DAVF) presenting with parkinsonism and dementia is rare; thus, is easily misdiagnosed. […] In conclusion, progressive parkinsonism and dementia with an abnormal flow void shadow on cranial MRI films should be considered as a possible diagnosis of a DAVF. […] Due to varying nonspecific clinical manifestations, the diagnosis of a DAVF is often based on imaging studies. […] Diagnosis is difficult using cranial CT; however, this imaging technique can reveal certain secondary changes caused by a DAVF, including venous sinus thrombosis, acute and sub-acute subarachnoid hemorrhage and subdural or cerebral hemorrhage. […] However, cranial MRI is better compared with CT for the detection of DAVF-induced secondary changes, and is useful to show the extensive flow void phenomenon.

• #46 Spinal dural arteriovenous fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/spinal-dural-arteriovenous-fistula?lang=us

  Spinal dural arteriovenous fistulas (SDAVF) are the most common type of spinal vascular malformation, accounting for ~70% of all such lesions. […] The incidence of SDAVF peaks in the 5th and 6th decades and males are more commonly affected than females. […] SDAVFs cause symptoms through venous hypertension and congestion of the cord with edema. The most common clinical presentations are progressive pain, lower extremity weakness or sensory changes. Sphincter dysfunction may also occur. The onset of symptoms is insidious with a slowly progressive course occurring over several years. There is often a significant delay between presentation and diagnosis. […] DSA is the gold standard test for confirming the diagnosis and it provides options for treatment. It is a time consuming and potentially dangerous investigation as dissection of a vessel can potentially lead to cord ischemia. […] Treatment options include endovascular or surgical occlusion of the shunt.

• #47 Frontiers | Intracranial Dural Arteriovenous Fistulas With Brainstem Engorgement: An Under-Recognized Entity in Diagnosis and Treatment

  https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.526550/full

  Intracranial Dural Arteriovenous Fistulas With Brainstem Engorgement: An Under-Recognized Entity in Diagnosis and Treatment […] Background: In rare circumstances, patients with intracranial (dural arteriovenous fistulas) DAVFs could be complicated with brainstem engorgement, which might lead to delayed or false diagnosis and subsequent improper management. […] Results: Thirty-three (40.2%, 33/82) patients were initially misdiagnosed as other diseases. […] The treatment outcome is still unsatisfactory at present. Early awareness of this rare entity and efficiently utilizing the up to date investigations are of utmost importance. […] The diagnosis of intracranial DAVFs with brainstem engorgement is still challenging. Patients that were diagnosed with neoplasm to undergo brainstem biopsy or given corticosteroids for misdiagnosing as myelitis were not uncommonly reported. According to our analysis, 40.2% (33/82) of the patients were initially misdiagnosed as other diseases. Of note, the rate of initial misdiagnosis did not decrease in the past three decades.

• #48 Frontiers | Intracranial Dural Arteriovenous Fistulas With Brainstem Engorgement: An Under-Recognized Entity in Diagnosis and Treatment

  https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2020.526550/full

  While conventional angiography is the gold standard for definite diagnosis of intracranial DAVFs, taking good advantage of different sequences of MRI data could help screen out those patients with high suspicion. Abnormal vascular flow voids on MRI are reliable evidence highly suggestive of vascular lesions. […] The prognosis of patients with DAVFs associated brainstem engorgement is still unsatisfactory, though slight increase in good recovery could be noted in the past three decades. Only 70% of the patients experienced a good recovery (mRS score ≤ 3). A substantial number of patients can have more or less neurological deficits.

• #49

  https://link.springer.com/article/10.1007/s00415-021-10571-0

  To describe the diagnostic features of intracranial dural arteriovenous fistulae (DAVF) presenting with cervical cord or brainstem swelling. […] Identification of dilated perimedullary veins through careful inspection of MR images is usually pivotal in making the diagnosis. […] However, late diagnosis is common, resulting in significant disability in many cases. […] Such cases are considered rare, but are probably under-diagnosed and often mistaken for acute transverse myelitis (ATM), a far commoner cause of cervical myelopathy. […] Misdiagnosis may have grave consequences, because steroids, the standard treatment for ATM, can prompt rapid neurological deterioration in half of spinal DAVF cases. […] The objective was to review the diagnostic characteristics of these cases, identifying pitfalls and clues that may aid earlier differentiation from ATM.

• #50

  https://link.springer.com/article/10.1007/s00415-021-10571-0

  To describe the diagnostic features of intracranial dural arteriovenous fistulae (DAVF) presenting with cervical cord or brainstem swelling. […] Identification of dilated perimedullary veins through careful inspection of MR images is usually pivotal in making the diagnosis. […] However, late diagnosis is common, resulting in significant disability in many cases. […] Such cases are considered rare, but are probably under-diagnosed and often mistaken for acute transverse myelitis (ATM), a far commoner cause of cervical myelopathy. […] Misdiagnosis may have grave consequences, because steroids, the standard treatment for ATM, can prompt rapid neurological deterioration in half of spinal DAVF cases. […] The objective was to review the diagnostic characteristics of these cases, identifying pitfalls and clues that may aid earlier differentiation from ATM.

• #51

  https://link.springer.com/article/10.1007/s00415-021-10571-0

  The clinical, CSF, MRI and angiographic findings are summarised in Table 1. […] Steroids were administered more frequently for presumed ATM with Cognard type V DAVF (5/6) compared to spinal (1/27, cervical) DAVF. […] Acute or hyperacute deterioration was observed in 4/6 cases. […] Clinical deterioration after steroid treatment occurred in 4/5 cases. […] The following features may suggest DAVF rather than myelitis: older male patients (6/6), symptomatic progression over 4 or more weeks (6/6) and acellular CSF (5/5). […] Importantly, steroids can cause dramatic clinical deterioration of DAVF, probably through transient mineralocorticoid-induced hypervolemia and venous hypertension. […] The diagnosis of DAVF usually rests on standard MRI, can be guided by MR angiography (MRA) and is confirmed by digital subtraction angiography (DSA).

• #52 Delayed Diagnosis of Spinal Dural Arteriovenous Fistula: A Case Report and Scoping Review

  https://www.mdpi.com/2077-0383/13/3/711

  The primary reason for delayed and incorrect SDAVF diagnosis is that SDAVF is easily misrepresented as other diseases. […] The initial symptoms of SDAVF are nonspecific motor and sensory deficits affecting the lower extremities. […] SDAVF treatment includes microsurgery and embolization. The treatment goal is to prevent the flow of blood from the proximal intradural vein and fistula. […] Early diagnosis and treatment are therefore essential; results emphasize their importance in SDAVF. […] SDAVF is frequently misdiagnosed due to its nonspecific features, and late diagnosis can worsen the prognosis. Spinal MRI should be conducted in patients presenting symptoms such as slowly progressive lower-limb weakness, paresthesia, and vesicorectal dysfunction. […] Delayed diagnosis of DAVF usually causes long-term irreversible neurological complications. Thus, early diagnosis and intervention are crucial.

• #53

  https://journals.lww.com/neurosurgpraconline/fulltext/2023/09000/rupture_of_a_spinal_dural_arteriovenous_fistula_as.12.aspx

  Spinal dural arteriovenous fistulas (SDAVFs) are the most common vascular malformation of the spine and can lead to progressive paraplegia if left untreated. […] However, because of their nonspecific clinical presentation, they are often misdiagnosed as other pathologies, such as discopathies or degenerative neuropathies, which can result in delayed diagnosis and treatment. […] SDAVF is a disease with nonspecific initial symptoms, which can easily be mistaken for other pathologies. […] However, early recognition of the presence of the fistula, especially in cases of rupture, can improve prognosis and increase the chance of better outcomes. […] It is important to keep this condition in mind when evaluating patients with unexplained neurological symptoms and consider SDAVF as a differential diagnosis of acute coronary syndrome.

• #54 Diagnosis and treatment of a dural arteriovenous fistula presenting with progressive parkinsonism and dementia: A case report and literature review

  https://www.spandidos-publications.com/10.3892/etm.2014.2122

  In addition, with a serious condition, MRI can display tortuously enlarged cortical veins. […] An abnormal flow void area was identified in the left temporal lobe from the cranial MRI films, and subsequently CTA and DSA were essential for the final diagnosis. […] DSA is better for demonstrating the characteristics of a DAVF, including the site of the fistula, feeding features and venous return, and even can indirectly demonstrate the degree of fistula blood flow and intracranial hemodynamic characteristics. […] The treatment methods for DAVFs include embolization, vascular compression, surgery and stereotactic treatment. […] In conclusion, a DAVF presenting as parkinsonism and dementia is easily misdiagnosed. However, a timely diagnosis is crucial for improved therapeutic outcomes.

• #55

  https://journals.lww.com/md-journal/fulltext/2023/11100/dural_arteriovenous_fistula_with_progressive.101.aspx

  DSA can determine the location of the fistula, feeding artery, draining venous sinus, and cortical venous reflux; these features are which are the main bases for the diagnosis, classification, and treatment of DAVFs. Overall, DSA examination can allow a quick diagnosis, subsequently leading to prompt disease treatment. […] In conclusion, DAVFs accompanied by dementia and parkinsonism are easily misdiagnosed. Therefore, timely diagnosis is very important to improve treatment efficacy. For progressive dementia with Parkinson disease, when brain MRI scans show white matter lesions, the possibility of DAVF should be considered. Complete imaging examinations are needed concurrent with DSA examination and endovascular treatment to improve patients overall prognosis.

• #56

  https://link.springer.com/article/10.1007/s00415-021-10571-0

  The clinical, CSF, MRI and angiographic findings are summarised in Table 1. […] Steroids were administered more frequently for presumed ATM with Cognard type V DAVF (5/6) compared to spinal (1/27, cervical) DAVF. […] Acute or hyperacute deterioration was observed in 4/6 cases. […] Clinical deterioration after steroid treatment occurred in 4/5 cases. […] The following features may suggest DAVF rather than myelitis: older male patients (6/6), symptomatic progression over 4 or more weeks (6/6) and acellular CSF (5/5). […] Importantly, steroids can cause dramatic clinical deterioration of DAVF, probably through transient mineralocorticoid-induced hypervolemia and venous hypertension. […] The diagnosis of DAVF usually rests on standard MRI, can be guided by MR angiography (MRA) and is confirmed by digital subtraction angiography (DSA).

• #57 A Rare and Treatable Cause of Medullar Claudication: Spinal Dural Arteriovenous Fistula | Ochsner Journal

  https://www.ochsnerjournal.org/content/19/4/397

  Spinal dural arteriovenous fistula is a rare and underdiagnosed disorder. Because of the nonspecific clinical presentation of the condition, patients are often referred to different specialists, resulting in delayed diagnosis. […] Physicians should be aware of the specific abnormalities shown on spinal cord MRI that indicate dural arteriovenous fistula, as well as the criteria for performing medullar angiography, so that the condition can be diagnosed and treated in a timely manner. Early therapeutic treatment is the principal prognosis factor. […] The diagnosis is difficult to establish, and the mean delay to diagnosis is approximately 15 months. […] Imaging is crucial to confirm the diagnosis of spinal dural arteriovenous fistula. […] Medullar angiography is the gold standard for diagnosis and must be performed according to specific criteria. […] Early therapeutic treatment is the principal factor affecting prognosis.

• #58 Delayed Diagnosis of Spinal Dural Arteriovenous Fistula: A Case Report and Scoping Review

  https://www.mdpi.com/2077-0383/13/3/711

  The primary reason for delayed and incorrect SDAVF diagnosis is that SDAVF is easily misrepresented as other diseases. […] The initial symptoms of SDAVF are nonspecific motor and sensory deficits affecting the lower extremities. […] SDAVF treatment includes microsurgery and embolization. The treatment goal is to prevent the flow of blood from the proximal intradural vein and fistula. […] Early diagnosis and treatment are therefore essential; results emphasize their importance in SDAVF. […] SDAVF is frequently misdiagnosed due to its nonspecific features, and late diagnosis can worsen the prognosis. Spinal MRI should be conducted in patients presenting symptoms such as slowly progressive lower-limb weakness, paresthesia, and vesicorectal dysfunction. […] Delayed diagnosis of DAVF usually causes long-term irreversible neurological complications. Thus, early diagnosis and intervention are crucial.

• #59

  https://journals.lww.com/neurosurgpraconline/fulltext/2023/09000/rupture_of_a_spinal_dural_arteriovenous_fistula_as.12.aspx

  This case report highlights the importance of timely and accurate diagnosis of SDAVF in patients presenting with unexplained neurological symptoms. […] Timely recognition of SDAVF can improve prognosis and quality of life of affected patients. […] SDAVF can be initially evaluated with a spinal MRI, which typically reveals a high-signal intensity image with a swollen spinal cord in T2 sequences. […] However, spinal angiography remains the gold standard for diagnosis because it allows for the precise identification of the location of the fistula. […] The prognosis of SDAVF depends on the timing of diagnosis. […] An early and accurate diagnosis can prevent secondary complications such as rupture and subsequent hemorrhage, which can cause irreversible spinal cord injury. […] It is crucial for physicians to consider SDAVF as a possible differential diagnosis in patients with unexplained neurological symptoms, even in those with acute coronary syndrome, and perform a prompt and accurate diagnosis to enhance prognosis and recovery.

• #60 Tentorial dural arteriovenous fistula presenting as myelopathy: Case series and review of literature

  https://www.wjgnet.com/2307-8960/full/v2/i12/907.htm

  Dural arteriovenous fistula (DAVF) is a rare type of cerebral arteriovenous malformation. Common presenting symptoms are related to hemorrhage. However, rarely these patients may present with myelopathy. […] The usage of magnetic resonance imaging and selective angiography has significantly improved the ability to characterize DAVFs, however, these lesions remain inefficiently diagnosed. […] The optimal treatment of DAVFs remains controversial, and there is an ongoing debate as to whether primary endovascular or primary microsurgical treatment is the optimal management for these lesions. […] This review highlights the classification of dural AV fistulas, the various diagnostic modalities available for diagnosis and management strategies employed for the treatment of DAVF. […] MRI findings can be subtle and difficult to interpret. These include prominent perimedullary flow voids as well as T2 signal intensity in the brainstem and spinal cord indicating the presence of venous congestion and edema. […] Cerebral angiography is the gold standard for diagnosis. […] The optimal management strategy for DAVF is still controversial. […] Early diagnosis is important in these cases as a prompt intervention can result in great functional outcomes as evidenced by our cases.

• #61 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532274/

  A six-vessel cerebral digital subtraction angiogram (DSA) is required to establish the diagnosis and plan treatment. […] The decision of whether to treat dAVFs is based on the patient’s symptoms, medical comorbidities, and risk of intracranial hypertension or hemorrhage. […] An integrated approach with a team of healthcare professionals is recommended to make an early diagnosis and appropriate treatment.

• #62 Dural arteriovenous fistula – Wikipedia

  https://en.wikipedia.org/wiki/Dural_arteriovenous_fistula

  Cerebral angiography is the diagnostic standard. MRIs are typically normal but can identify venous hypertension as a result of arterial-venous shunting. […] The Borden Classification of dural arteriovenous malformations or fistulas, groups into three types based upon their venous drainage. […] Type II fistulas need to be treated to prevent hemorrhage. The treatment may involve embolization of the draining sinus as well as clipping or embolization of the draining veins. […] Type III dural AV fistulas drain directly into subarachnoid veins. These veins can form aneurysms and bleed. Type III dural fistulas need to be treated to prevent hemorrhage. Treatment can be as simple as clipping the draining vein at the site of the dural sinus. […] Treatment decisions are more complicated and require a consultation with a multidisciplinary team consisting of at least a interventional neuroradiologist, neurosurgeon and radiotherapist familiar with these lesions.

• #63 Introduction. Dural arteriovenous fistulas: multimodal diagnosis, management, and outcomes in: Neurosurgical Focus Volume 56 Issue 3 (2024) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/56/3/article-pE1.xml

  Dural arteriovenous fistulas (DAVFs) are relatively rare lesions that comprise an abnormal communication between meningeal arteries and dural venous sinuses, cortical veins, or spinal cord veins. […] This issue of Neurosurgical Focus is instrumental in providing a comprehensive review of common DAVFs, diagnostic and clinical presentations, multimodal approaches, and their long-term outcomes, in addition to unique technological advancements in their management. […] DAVFs remain complex arteriovenous anomalies requiring careful clinical evaluation and consideration for treatment with a single or multidisciplinary approach. This Neurosurgical Focus issue provides a guide for the diagnosis, management, and outcome of DAVFs, in the context of recent technological advancements in the field.

• #64 Dural Arteriovenous Fistula (DAVF) – Cerebrovascular Disease | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/cerebrovascular/conditions/dural-arteriovenous-fistula-davf

  Arteriovenous fistulas occur when abnormal connections form directly from arteries to veins. […] When this connection occurs in the dura mater, they are called Dural Arteriovenous Fistulas (DAVFs). […] Each dural arteriovenous fistulas is unique and should be evaluated by neurovascular experts, such as the multidisciplinary team at UCLA. […] If a DAVF is suspected, it is important to make a diagnosis and consult with a specialist quickly to prevent worsening of the disease. […] At UCLA, we use the most advanced technology and latest imaging systems to diagnose arteriovenous fistulas of the brain and spine quickly and accurately. […] During your examination, your expert team may use the following imaging techniques to locate and assess your AVF: Magnetic resonance imaging (MRI) scans, including magnetic resonance angiography (MRA) and venography (MRV), are used to identify and locate an AVF.

• #65 Dural Arteriovenous Fistula (DAVF) – Cerebrovascular Disease | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/cerebrovascular/conditions/dural-arteriovenous-fistula-davf

  Catheter angiography provides the most accurate images of the blood vessels affected by the AVF. […] The higher the DAVF grade, the higher the risk of brain bleeding or neurologic problems. […] After your diagnosis, a multidisciplinary team of neurovascular experts will meet to review your case and create a customized treatment plan. […] DAVF diagnosis and treatment procedures are performed at Ronald Reagan UCLA Medical Center.

• #66 Dural arteriovenous fistula | Inselspital, Bern University Hospital

  https://neurochirurgie.insel.ch/en/diseases-specialities/cerebral-vessels/dural-arteriovenous-fistula

  Dural arteriovenous fistulas (dAVFs) are acquired vascular malformations in which there is a pathological connection between arterial vessels of the meninges and venous vessels of the brain or spinal cord. […] Dural arteriovenous fistulas account for about 10-15% of all arteriovenous malformations and are therefore quite rare. […] Diagnosis of a dural arteriovenous fistula in the brain or spinal cord requires magnetic resonance imaging (MRI) as well as diagnostic subtraction angiography for selective visualization of the vessels. […] The examination results, treatment steps and follow-up planning for patients with dAVFs are jointly reviewed and discussed at Inselspital by a multidisciplinary team of neurosurgeons and neuroradiologists.

• #67 Spinal dural arteriovenous fistula | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/spinal-dural-arteriovenous-fistula?lang=us

  Spinal dural arteriovenous fistulas (SDAVF) are the most common type of spinal vascular malformation, accounting for ~70% of all such lesions. […] The incidence of SDAVF peaks in the 5th and 6th decades and males are more commonly affected than females. […] SDAVFs cause symptoms through venous hypertension and congestion of the cord with edema. The most common clinical presentations are progressive pain, lower extremity weakness or sensory changes. Sphincter dysfunction may also occur. The onset of symptoms is insidious with a slowly progressive course occurring over several years. There is often a significant delay between presentation and diagnosis. […] DSA is the gold standard test for confirming the diagnosis and it provides options for treatment. It is a time consuming and potentially dangerous investigation as dissection of a vessel can potentially lead to cord ischemia. […] Treatment options include endovascular or surgical occlusion of the shunt.

• #68 Spinal Dural Arteriovenous Fistula: The Missing-Piece Sign | Ochsner Journal

  https://www.ochsnerjournal.org/content/22/1/10

  Spinal dural arteriovenous fistulas (sDAVFs) are a rare and often underdiagnosed spinal pathology. […] Early diagnosis of sDAVFs is important; deficits are potentially reversible, but delayed treatment may result in irreversible neurologic disability. […] Imaging diagnosis primarily relies on magnetic resonance imaging (MRI) and conventional spinal angiography. […] A characteristic enhancement pattern for sDAVFs known as the missing-piece sign has been recently (2018) described in the literature. […] The missing-piece sign can be seen on MRI and is defined as at least one discrete region of nonenhancement within a long segment of intense spinal cord gadolinium enhancement. […] A missing-piece sign pattern of enhancement, along with perimedullary vascular flow voids, should prompt additional evaluation with angiography.

• #69 Spinal Dural Arteriovenous Fistula: The Missing-Piece Sign | Ochsner Journal

  https://www.ochsnerjournal.org/content/22/1/10

  Although computed tomography angiography and magnetic resonance angiography have been shown to be useful in identifying, classifying, and aiding in treatment planning of sDAVFs, conventional spinal angiography remains the gold standard for diagnosis and classification. […] Familiarity with imaging features of sDAVFs can prevent unnecessary delay in diagnosis and treatment, as well as further invasive testing for pathologies with similar presenting symptoms.

• #70 Dural arteriovenous fistula with spinal dural arteriovenous fistula: a case report and review of the literature | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/s13256-023-04170-y

  The diagnosis of SDAVF depends on imaging, where MRI reveals a perimedullary vermiform vascular shadow, as well as spinal cord degeneration and edema. […] Like DAVF, definitive diagnosis depends on the „gold standard,” DSA. […] The diagnosis of SDAVF is often challenging to diagnose. […] The first-diagnosing hospital analyzed the patient’s clinical manifestations and prioritized the investigation of craniocerebral diseases. […] After the patient arrived at our hospital, the investigation into the spinal cord disease continued, and finally, SDAVF was definitively diagnosed via imaging. […] Many studies pointed out that DAVF and SDAVF should be diagnosed and treated as early as possible by blocking the blood flow to the fistula, reducing the pressure in the cortex, and intramedullary vein, alleviating edema and ischemic changes and reducing clinical symptoms and nerve function damage.

• #71 Spinal Dural Arteriovenous Fistula: The Missing-Piece Sign | Ochsner Journal

  https://www.ochsnerjournal.org/content/22/1/10

  Although computed tomography angiography and magnetic resonance angiography have been shown to be useful in identifying, classifying, and aiding in treatment planning of sDAVFs, conventional spinal angiography remains the gold standard for diagnosis and classification. […] Familiarity with imaging features of sDAVFs can prevent unnecessary delay in diagnosis and treatment, as well as further invasive testing for pathologies with similar presenting symptoms.

• #72

  https://link.springer.com/article/10.1007/s00234-008-0393-7

  We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. […] The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. […] Five patients underwent endovascular treatment: transarterial embolization (TAE; n=2), transvenous embolization (TVE; n=2), and TAE/TVE (n=1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. […] Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking.

• #73

  https://link.springer.com/article/10.1007/s00234-008-0393-7

  We report the characteristics, diagnosis and treatment of dural arteriovenous fistula (DAVF) of the hypoglossal canal in nine patients with this relatively rare vascular disorder. […] The incidence of hypoglossal canal DAVF was not very low in our series. Contralateral carotid injection is an essential examination to provide an accurate diagnosis. […] Five patients underwent endovascular treatment: transarterial embolization (TAE; n=2), transvenous embolization (TVE; n=2), and TAE/TVE (n=1). Complete shunt obliteration was achieved in four patients and shunt reduction in one. […] Postoperative hypoglossal nerve palsy occurred in one patient after TVE, possibly due to coil overpacking.

• #74 Dural arteriovenous fistulas presenting with brainstem dysfunction: diagnosis and surgical treatment in: Neurosurgical Focus Volume 32 Issue 5 (2012) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/32/5/2012.2.focus1217.xml

  In this paper we present 2 patients with brainstem dysfunction secondary to DAVF. […] Our literature search followed by a secondary review of the associated references in the primary sources revealed only 4 reported Cognard Type V DAVFs presenting as brainstem ischemia in the English literature, with a fifth case in the Japanese literature. […] Our report emphasizes the need to further evaluate brainstem stroke of unknown origin through more comprehensive vascular studies, including cerebral angiograms. […] The primary mechanism responsible for brainstem dysfunction among the patients noted above is believed to be venous hypertension secondary to arterial pressure via the fistula. […] Our 2 cases demonstrate that although previous reports largely relied on endovascular embolization occlusion techniques, open surgical disconnection is feasible, safe, and efficacious for both cerebral and cervical lesions. […] Prompt diagnosis and treatment are important to provide the patient with the best chance at improvement.

• #75 Dural arteriovenous fistulas presenting with brainstem dysfunction: diagnosis and surgical treatment in: Neurosurgical Focus Volume 32 Issue 5 (2012) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/32/5/2012.2.focus1217.xml

  In this paper we present 2 patients with brainstem dysfunction secondary to DAVF. […] Our literature search followed by a secondary review of the associated references in the primary sources revealed only 4 reported Cognard Type V DAVFs presenting as brainstem ischemia in the English literature, with a fifth case in the Japanese literature. […] Our report emphasizes the need to further evaluate brainstem stroke of unknown origin through more comprehensive vascular studies, including cerebral angiograms. […] The primary mechanism responsible for brainstem dysfunction among the patients noted above is believed to be venous hypertension secondary to arterial pressure via the fistula. […] Our 2 cases demonstrate that although previous reports largely relied on endovascular embolization occlusion techniques, open surgical disconnection is feasible, safe, and efficacious for both cerebral and cervical lesions. […] Prompt diagnosis and treatment are important to provide the patient with the best chance at improvement.

• #76 Arteriovenous Fistula Diagnosis | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-fistula/types/diagnosing

  Dural arteriovenous fistulas (dAVFs) are rare and intricate vascular anomalies characterized by abnormal connections between arteries and veins within the protective membrane covering the brain, known as the dura mater. […] Timely diagnosis and treatment are crucial, as not all dAVFs are created equal, and their management can vary widely. […] The diagnosis of dAVF is done in a stepwise fashion, starting with initial symptoms of concern, and progressing through various diagnostic modalities until a clear clinical picture is established. […] Once a collection of concerning symptoms is described, the care team may order non-invasive imaging studies; Magnetic resonance imaging (MRI) and computed tomography (CT) scans being the most commonly used methods. […] Formal angiography, also known as digital subtraction angiography (DSA), is the gold standard for diagnosing dAVFs.

• #77 Arteriovenous Fistula Diagnosis | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-fistula/types/diagnosing

  The best way to diagnose AVFs involves a combination of non-invasive imaging techniques, followed by invasive angiography when necessary. […] This classification helps doctors understand the blood flow pattern and risks associated with different types of AVFs. […] On a computed tomography (CT) scan, an arteriovenous fistula typically appears as an area of increased density or abnormal contrast enhancement. […] Cerebral angiography, on the other hand, offers a more detailed and dynamic view of arteriovenous fistulas. […] The treatment options for dural arteriovenous fistulas (dAVFs) can be categorized into three main approaches: endovascular embolization, surgery, and radiosurgery. […] Diagnosis of AVFs combines non-invasive imaging and, when needed, invasive angiography.

• #78 Arteriovenous Fistula Diagnosis | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-fistula/types/diagnosing

  Dural arteriovenous fistulas (dAVFs) are rare and intricate vascular anomalies characterized by abnormal connections between arteries and veins within the protective membrane covering the brain, known as the dura mater. […] Timely diagnosis and treatment are crucial, as not all dAVFs are created equal, and their management can vary widely. […] The diagnosis of dAVF is done in a stepwise fashion, starting with initial symptoms of concern, and progressing through various diagnostic modalities until a clear clinical picture is established. […] Once a collection of concerning symptoms is described, the care team may order non-invasive imaging studies; Magnetic resonance imaging (MRI) and computed tomography (CT) scans being the most commonly used methods. […] Formal angiography, also known as digital subtraction angiography (DSA), is the gold standard for diagnosing dAVFs.

• #79 Dural Arteriovenous Fistula (DAVF) – Cerebrovascular Disease | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/cerebrovascular/conditions/dural-arteriovenous-fistula-davf

  Arteriovenous fistulas occur when abnormal connections form directly from arteries to veins. […] When this connection occurs in the dura mater, they are called Dural Arteriovenous Fistulas (DAVFs). […] Each dural arteriovenous fistulas is unique and should be evaluated by neurovascular experts, such as the multidisciplinary team at UCLA. […] If a DAVF is suspected, it is important to make a diagnosis and consult with a specialist quickly to prevent worsening of the disease. […] At UCLA, we use the most advanced technology and latest imaging systems to diagnose arteriovenous fistulas of the brain and spine quickly and accurately. […] During your examination, your expert team may use the following imaging techniques to locate and assess your AVF: Magnetic resonance imaging (MRI) scans, including magnetic resonance angiography (MRA) and venography (MRV), are used to identify and locate an AVF.

• #80 Arteriovenous Fistula Diagnosis | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-fistula/types/diagnosing

  The best way to diagnose AVFs involves a combination of non-invasive imaging techniques, followed by invasive angiography when necessary. […] This classification helps doctors understand the blood flow pattern and risks associated with different types of AVFs. […] On a computed tomography (CT) scan, an arteriovenous fistula typically appears as an area of increased density or abnormal contrast enhancement. […] Cerebral angiography, on the other hand, offers a more detailed and dynamic view of arteriovenous fistulas. […] The treatment options for dural arteriovenous fistulas (dAVFs) can be categorized into three main approaches: endovascular embolization, surgery, and radiosurgery. […] Diagnosis of AVFs combines non-invasive imaging and, when needed, invasive angiography.

• #81 Frontiers | Diagnostic, clinical management, and outcomes in patients with spinal dural arteriovenous fistula

  https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2024.1374321/full

  Spinal dural arteriovenous fistulas (SDAVFs) are rare spinal vascular malformations, but account for 70 to 80% of all spinal arteriovenous malformations. […] Spinal digital subtraction angiography (DSA) is considered to be the gold standard for the diagnosis of SDAVF. […] The diagnosis is confirmed by digital subtraction angiography (DSA). […] All patients had undergone preoperative spinal angiography to confirm the suspected diagnosis of SDAVF after the initial MRI or MRA examination revealed suspicious findings such as flow voids and myelopathy (81, 100%). […] The aim of treatment is to interrupt the fistulous arterial and venous point. […] The Diagnosis is often difficult to find. […] The development of high-resolution DSA has improved the assessment of the exact location of SDAVF fistulous point.

• #82 Frontiers | Diagnostic, clinical management, and outcomes in patients with spinal dural arteriovenous fistula

  https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2024.1374321/full

  Previous studies on SDAVFs concentrated mainly on outcome comparisons between endovascular and surgical treatment. […] The location of the fistula was precisely determined using conventional fluoroscopy prior to the surgical procedure. […] A postoperative spinal DSA or MRI/MRA was performed within the first 3 days after treatment to assess fistula closure and any postoperative complications. […] The median of American Spinal Injury Association motor score (ASIA-MS) was 94 [82.5–100] at admission, 98 [86.5–100] at hospital discharge, 100 [90–100] at the first, second, and third follow-up. […] Our retrospective cohort study and 22 years of experience with SDAVF demonstrate safe therapy with significantly reduce in pain, improvement in gait disturbance, motor deficit, bowel, and bladder dysfunction in the short and long term, but not in sensory disturbances.

• #83 Cranial Dural Arteriovenous Fistula: Diagnosis and Classification with Time-Resolved MR Angiography at 3T | American Journal of Neuroradiology

  https://www.ajnr.org/content/30/8/1546

  The diagnosis of dural arteriovenous fistula (DAVF) remains one of the few uncontested indications for catheter based cerebral angiography. […] We report our experience of using a commercially available form of time-resolved MR angiography (trMRA) at 3T for the diagnosis and classification of a cranial DAVF compared with the reference standard of digital subtraction angiography (DSA). […] The reported result of the DSA was used as the gold standard against which the performance of the trMRA was measured. […] In 93% (39/42) of DAVF cases, the 3 readers were unanimous and correct in their independent interpretation of the trMRA, correctly identifying (or excluding) all fistulas and accurately classifying them when encountered. […] In this small series, trMRA at 3T seems be a reliable technique in the screening and surveillance of DAVF in specific clinical situations.

• #84 Cranial Dural Arteriovenous Fistula: Diagnosis and Classification with Time-Resolved MR Angiography at 3T | American Journal of Neuroradiology

  https://www.ajnr.org/content/30/8/1546

  The diagnosis of a cranial dural arteriovenous fistula (DAVF) has traditionally been made with catheter-based cerebral intra-arterial digital subtraction angiography (DSA). […] Although the diagnosis of DAVF may commonly be suspected on planar CT and MR imaging, DSA, with its high spatial and temporal resolution, has been required to confirm the diagnosis and define the lesion. […] We report here our experience with using a technique of whole-head, trMRA at 3T for the diagnosis and classification of DAVF compared with the reference standard of DSA. […] The reported result of the DSA examination regarding the presence, location, and classification of the fistula was used as the criterion standard against which the performance of the trMRA was compared. […] The consensus opinion among the readers with use of this form of trMRA (vs DSA as the criterion standard) was 100% sensitive and 100% specific, not only for DAVF identification but for correct grading of the fistula.

• #85 Dural Arteriovenous Fistula (dAVF): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/dural-arteriovenous-fistula-davf

  A healthcare provider will make a dural arteriovenous fistula diagnosis after: […] A healthcare provider may use the following imaging tests to get a better look at your blood vessels to diagnose a dural arteriovenous fistula: […] If there’s suspicion of a dAVF on the imaging, your healthcare providers may talk with you about a diagnostic test called a cerebral angiogram. […] A cerebral angiogram is a minimally invasive test that provides the best possible pictures of the vessels in your brain. […] Treatment can remove the fistula and improve blood flow in your blood vessels as expected. […] The goal of dural arteriovenous fistula treatment is to remove the abnormal connection (fistula) between your artery and vein. […] Your healthcare provider will determine the best treatment plan for you based on the anatomy of the dAVF, your general health, symptoms and risk of bleeding or complications.

• #86 Dural Arteriovenous Fistula (dAVF): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/dural-arteriovenous-fistula-davf

  If you don’t have symptoms, your healthcare provider may not immediately treat the condition but offer regular monitoring to prevent complications. […] Your prognosis depends on many factors, like the location of the fistula and whether bleeding has occurred. […] With early discovery and treatment, your prognosis is positive. […] Your healthcare provider will give you the most accurate outlook based on your situation.

• #87 Dural Arteriovenous Fistula Causes, Symptoms, and Treatments

  https://www.upmc.com/services/neurosurgery/brain/conditions/neurovascular-conditions/conditions/dural-arteriovenous-fistula

  Dural arteriovenous fistulas (dAVFs) are rare, abnormal connections between arteries and veins in the dura, the protective lining of your brain. […] To diagnose dAVF, your doctor will perform a physical exam and order imaging tests. […] Your doctor may order imaging tests to diagnose dAVF, including: CT or MR angiogram, CT scan, MRI. […] dAVF is a life-threatening condition. Your prognosis after dAVF will depend on the severity of your condition, whether it causes symptoms, and how quickly you receive medical care. […] The goals of dAVF treatment are to reduce your risk of stroke and other complications. Treatment for dAVF depends on the severity of your symptoms, if any, your overall condition, and whether you have low- or high-risk dAVF.

• #88 Dural Arteriovenous Fistula (dAVF): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/dural-arteriovenous-fistula-davf

  A healthcare provider will make a dural arteriovenous fistula diagnosis after: […] A healthcare provider may use the following imaging tests to get a better look at your blood vessels to diagnose a dural arteriovenous fistula: […] If there’s suspicion of a dAVF on the imaging, your healthcare providers may talk with you about a diagnostic test called a cerebral angiogram. […] A cerebral angiogram is a minimally invasive test that provides the best possible pictures of the vessels in your brain. […] Treatment can remove the fistula and improve blood flow in your blood vessels as expected. […] The goal of dural arteriovenous fistula treatment is to remove the abnormal connection (fistula) between your artery and vein. […] Your healthcare provider will determine the best treatment plan for you based on the anatomy of the dAVF, your general health, symptoms and risk of bleeding or complications.

• #89 Dural Arteriovenous Fistula Causes, Symptoms, and Treatments

  https://www.upmc.com/services/neurosurgery/brain/conditions/neurovascular-conditions/conditions/dural-arteriovenous-fistula

  Dural arteriovenous fistulas (dAVFs) are rare, abnormal connections between arteries and veins in the dura, the protective lining of your brain. […] To diagnose dAVF, your doctor will perform a physical exam and order imaging tests. […] Your doctor may order imaging tests to diagnose dAVF, including: CT or MR angiogram, CT scan, MRI. […] dAVF is a life-threatening condition. Your prognosis after dAVF will depend on the severity of your condition, whether it causes symptoms, and how quickly you receive medical care. […] The goals of dAVF treatment are to reduce your risk of stroke and other complications. Treatment for dAVF depends on the severity of your symptoms, if any, your overall condition, and whether you have low- or high-risk dAVF.

• #90 Dural arteriovenous fistulas – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/dural-arteriovenous-fistulas/symptoms-causes/syc-20364280

  Dural arteriovenous fistulas (dAVFs) are irregular connections between arteries and veins. […] Treatment for dAVF usually involves an endovascular procedure or stereotactic radiosurgery to block the blood flow to the dAVF. Or surgery may be needed to disconnect or remove the dAVF. […] Most dural arteriovenous fistulas (dAVFs) have no clear origin. But some result from a traumatic head injury, infection, previous brain surgery, blood clots in deep veins or tumors. […] Most experts think that dAVFs involving larger brain veins occur from the narrowing or blockage of one of the brain’s venous sinuses. The venous sinuses are channels in the brain that route circulated blood from the brain back to the heart.

• #91 Arteriovenous Fistula Diagnosis | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-fistula/types/diagnosing

  The best way to diagnose AVFs involves a combination of non-invasive imaging techniques, followed by invasive angiography when necessary. […] This classification helps doctors understand the blood flow pattern and risks associated with different types of AVFs. […] On a computed tomography (CT) scan, an arteriovenous fistula typically appears as an area of increased density or abnormal contrast enhancement. […] Cerebral angiography, on the other hand, offers a more detailed and dynamic view of arteriovenous fistulas. […] The treatment options for dural arteriovenous fistulas (dAVFs) can be categorized into three main approaches: endovascular embolization, surgery, and radiosurgery. […] Diagnosis of AVFs combines non-invasive imaging and, when needed, invasive angiography.

• #92 Dural Arteriovenous Fistula – Symptoms and Treatment | Neuroaxis

  https://neuroaxis.com.au/conditions-treated/cerebrovascular-diseases/dural-av-fistulas/

  Dural arteriovenous fistulas (DAVFs) are abnormal, rare connections between veins and arteries in the dura matter (lining of the brain or spinal cord). […] The diagnosis of DAVF is usually done using imaging techniques such as CT angiography (CTA), CT scan, MRI, or angiography. […] DAVFs appear in both women and men after the age of 50 to 60 years along with haemorrhage. But still, Dural AV fistulas are observed more commonly in men. […] The endovascular embolism treatment approach is usually considered as the first line of treatment option for DAVF. Both transvenous and transarterial methods are used to cure the patient from DAVF. […] Some of the risks of endovascular treatment of DAVF include an increased risk of hypertension, haemorrhage and leptomeningeal venous varix. […] DAVF with cortical venous drainage can have relatively high risk of recurrent neurological events or haemorrhage. […] DAVF recurrence may happen despite initial cure. There may be a delay in recurrence if there is incomplete penetration of the embolic material into the proximal portion of the venous outlet.

• #93 Dural Arteriovenous Fistula (DAVF) | Boston Medical Center

  https://www.bmc.org/patient-care/conditions-we-treat/db/dural-arteriovenous-fistula-davf

  Dural arteriovenous fistulas (DAVF) are abnormal connections between arteries and veins near the brain. […] Before recommending treatment, an imaging study of the brain is required with CT (computed tomography) scan or MRI (magnetic resonance imaging). An angiogram is also necessary, in which a catheter is inserted into an artery in the groin and dye is injected into the pertinent arteries of interest. […] Thomas underwent a cerebral angiogram a diagnostic imaging test that helps to find blockages or other abnormalities in the blood vessels of the head and neck which confirmed a left frontal dural arteriovenous fistula with cortical venous reflux. […] The catheter angiogram revealed Chris had an extensive dural arteriovenous fistula (dAVF) involving the base of the skull adjacent to the cranial nerves and the ear.

• #94 Dural arteriovenous fistula – Wikipedia

  https://en.wikipedia.org/wiki/Dural_arteriovenous_fistula

  Cerebral angiography is the diagnostic standard. MRIs are typically normal but can identify venous hypertension as a result of arterial-venous shunting. […] The Borden Classification of dural arteriovenous malformations or fistulas, groups into three types based upon their venous drainage. […] Type II fistulas need to be treated to prevent hemorrhage. The treatment may involve embolization of the draining sinus as well as clipping or embolization of the draining veins. […] Type III dural AV fistulas drain directly into subarachnoid veins. These veins can form aneurysms and bleed. Type III dural fistulas need to be treated to prevent hemorrhage. Treatment can be as simple as clipping the draining vein at the site of the dural sinus. […] Treatment decisions are more complicated and require a consultation with a multidisciplinary team consisting of at least a interventional neuroradiologist, neurosurgeon and radiotherapist familiar with these lesions.

• #95 Tentorial dural arteriovenous fistula presenting as myelopathy: Case series and review of literature

  https://www.wjgnet.com/2307-8960/full/v2/i12/907.htm

  Dural arteriovenous fistula (DAVF) is a rare type of cerebral arteriovenous malformation. Common presenting symptoms are related to hemorrhage. However, rarely these patients may present with myelopathy. […] The usage of magnetic resonance imaging and selective angiography has significantly improved the ability to characterize DAVFs, however, these lesions remain inefficiently diagnosed. […] The optimal treatment of DAVFs remains controversial, and there is an ongoing debate as to whether primary endovascular or primary microsurgical treatment is the optimal management for these lesions. […] This review highlights the classification of dural AV fistulas, the various diagnostic modalities available for diagnosis and management strategies employed for the treatment of DAVF. […] MRI findings can be subtle and difficult to interpret. These include prominent perimedullary flow voids as well as T2 signal intensity in the brainstem and spinal cord indicating the presence of venous congestion and edema. […] Cerebral angiography is the gold standard for diagnosis. […] The optimal management strategy for DAVF is still controversial. […] Early diagnosis is important in these cases as a prompt intervention can result in great functional outcomes as evidenced by our cases.

• #96 Dural Arteriovenous Fistula (DAVF) – Cerebrovascular Disease | UCLA Health

  https://www.uclahealth.org/medical-services/neurosurgery/cerebrovascular/conditions/dural-arteriovenous-fistula-davf

  Catheter angiography provides the most accurate images of the blood vessels affected by the AVF. […] The higher the DAVF grade, the higher the risk of brain bleeding or neurologic problems. […] After your diagnosis, a multidisciplinary team of neurovascular experts will meet to review your case and create a customized treatment plan. […] DAVF diagnosis and treatment procedures are performed at Ronald Reagan UCLA Medical Center.

• #97 Updates in the management of cranial dural arteriovenous fistula | Stroke and Vascular Neurology

  https://svn.bmj.com/content/5/1/50

  Dural arteriovenous fistula (dAVF) accounts for approximately 10% of all intracranial vascular malformations. […] Endovascular treatment is often the first line of treatment for dAVF. […] For diagnosis, CT and MRI are usually unremarkable in dAVF. […] Dedicated vascular imaging is considered standard for diagnosis of a fistula. […] Cerebral digital subtraction angiography (DSA) is the gold standard imaging modality to detect and best characterise dAVF. […] Endovascular treatment is generally the first-line treatment for dAVF. […] Follow-up angiography is required to confirm long-term occlusion of dAVF and the durability of treatment.

• #98 Dural Arteriovenous Fistula (AVF) | University of Michigan Health

  https://www.uofmhealth.org/radiology-and-imaging/neurointerventional-radiology/dural-arteriovenous-fistula

  Location of the dural AVF is one of the key elements to a frequently observed symptom, i.e. whooshing or heartbeat noise that can be constantly or intermittently heard, usually in one ear. […] Classification of dural AVFs is important because this indicates a patients risk of bleeding from the fistula and the consequences that may occur from a bleed. […] Class 2 and 3 fistulas represent a significant risk to a patient from intracranial bleeding. These fistulas should be treated promptly. […] The treatment for dural AVFs can include embolization, surgery, and in some cases radiosurgery. […] If an AVF has bled and/or is in an area that can be easily operated upon, then surgical removal may be recommend. […] A person with an AVF should have regular checkups with his or her doctor.

• #99

  https://journals.lww.com/neurosurgpraconline/fulltext/2023/09000/rupture_of_a_spinal_dural_arteriovenous_fistula_as.12.aspx

  This case report highlights the importance of timely and accurate diagnosis of SDAVF in patients presenting with unexplained neurological symptoms. […] Timely recognition of SDAVF can improve prognosis and quality of life of affected patients. […] SDAVF can be initially evaluated with a spinal MRI, which typically reveals a high-signal intensity image with a swollen spinal cord in T2 sequences. […] However, spinal angiography remains the gold standard for diagnosis because it allows for the precise identification of the location of the fistula. […] The prognosis of SDAVF depends on the timing of diagnosis. […] An early and accurate diagnosis can prevent secondary complications such as rupture and subsequent hemorrhage, which can cause irreversible spinal cord injury. […] It is crucial for physicians to consider SDAVF as a possible differential diagnosis in patients with unexplained neurological symptoms, even in those with acute coronary syndrome, and perform a prompt and accurate diagnosis to enhance prognosis and recovery.

• #100 Dural arteriovenous fistula masquerading as pulsatile tinnitus: radiologic assessment and clinical implications | Scientific Reports

  https://www.nature.com/articles/srep36601

  In conclusion, given that PT can be the only initial symptom in more than 10% of dAVF, not only otolaryngologists but also neurologists and neurosurgeons should meticulously evaluate patients with PT to rule out the possibility of dAVF via a thorough history taking, physical examination, and audiological and psychoacoustic evaluations. When suspected, brain MRI/A and TFCA should be performed to diagnose and manage dAVF. In most cases, PT originating from dAVF can be cured by transarterial embolization regardless of the location and venous drainage pattern.

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