Materiały źródłowe

• #1 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

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

  The decision of whether to treat dAVFs is based on the patient’s symptoms, medical comorbidities, and risk of intracranial hypertension or hemorrhage. Lesions that are asymptomatic and low-grade tend to have a benign natural history and are generally managed conservatively with serial monitoring.[10] […] Those that are high-grade with cortical venous drainage or symptomatic are candidates for an intervention. Open surgery, endovascular embolization, and stereotactic radiosurgery are the main options for intervention. The goal of treatment is to achieve a complete disconnection of the fistula from its venous drainage. Incomplete disconnection may allow for the recruitment of other arteries to the fistula and may not improve the risk of hemorrhage or symptoms.[12] […] Surgical treatment involves the surgical disconnection of the fistula from the cortical venous system. Occasionally, skeletonization of the dural sinus with disconnection of the dural arterial supply, packing of the sinus, or resection of the involved dura is performed. Surgery is usually indicated in cases in which endovascular approaches have failed or can not be performed. In addition, those involving the floor of the anterior cranial fossa are usually treated surgically.

• #2 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

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

  The decision of whether to treat dAVFs is based on the patient’s symptoms, medical comorbidities, and risk of intracranial hypertension or hemorrhage. Lesions that are asymptomatic and low-grade tend to have a benign natural history and are generally managed conservatively with serial monitoring.[10] […] Those that are high-grade with cortical venous drainage or symptomatic are candidates for an intervention. Open surgery, endovascular embolization, and stereotactic radiosurgery are the main options for intervention. The goal of treatment is to achieve a complete disconnection of the fistula from its venous drainage. Incomplete disconnection may allow for the recruitment of other arteries to the fistula and may not improve the risk of hemorrhage or symptoms.[12] […] Surgical treatment involves the surgical disconnection of the fistula from the cortical venous system. Occasionally, skeletonization of the dural sinus with disconnection of the dural arterial supply, packing of the sinus, or resection of the involved dura is performed. Surgery is usually indicated in cases in which endovascular approaches have failed or can not be performed. In addition, those involving the floor of the anterior cranial fossa are usually treated surgically.

• #3 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. Both transarterial and transvenous approaches are used to cure dAVF. […] Surgery and, to a lesser extent, stereotactic radiosurgery are used when endovascular approaches are impossible or unsuccessful. […] Because of the benign nature, dAVFs without CVR (grades I and II) are often managed conservatively. Treatment can be palliative for patients who suffer from incapacitant tinnitus, ocular symptoms or severe headache. […] Various treatment modalities are used to manage aggressive dAVFs, including endovascular techniques, surgery, radiosurgery or a combination of these treatments. […] Endovascular approach is the first-line treatment for most dAVFs.

• #4 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

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

  The decision of whether to treat dAVFs is based on the patient’s symptoms, medical comorbidities, and risk of intracranial hypertension or hemorrhage. Lesions that are asymptomatic and low-grade tend to have a benign natural history and are generally managed conservatively with serial monitoring.[10] […] Those that are high-grade with cortical venous drainage or symptomatic are candidates for an intervention. Open surgery, endovascular embolization, and stereotactic radiosurgery are the main options for intervention. The goal of treatment is to achieve a complete disconnection of the fistula from its venous drainage. Incomplete disconnection may allow for the recruitment of other arteries to the fistula and may not improve the risk of hemorrhage or symptoms.[12] […] Surgical treatment involves the surgical disconnection of the fistula from the cortical venous system. Occasionally, skeletonization of the dural sinus with disconnection of the dural arterial supply, packing of the sinus, or resection of the involved dura is performed. Surgery is usually indicated in cases in which endovascular approaches have failed or can not be performed. In addition, those involving the floor of the anterior cranial fossa are usually treated surgically.

• #5 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. […] Treatment largely depends on the classification of the fistula and the age and comorbidities of the patient, as well as the presence of symptoms directly attributable to the fistula. […] Conservative (especially Borden type I and Cognard types I and IIa) […] Higher grades (Borden types II and III, Cognard types IIb-V) have an annual mortality rate of ~10% and an annual risk of intracranial hemorrhage of ~8%, so treatment should be considered: endovascular, surgical resection, stereotactic radiosurgery.

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

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

  Mayo Clinic neurosurgeons review surgical options for a dural arteriovenous fistula. […] Treatment for a dural arteriovenous fistula (dAVF) involves a procedure to block or disconnect the fistula. […] Procedures that can treat dAVF include: […] In an endovascular procedure, a long, thin tube called a catheter is inserted into a blood vessel in your leg or groin. It is threaded through blood vessels to the dural arteriovenous fistula using X-ray imaging. Coils or a glue-like substance is released to block the connection in the blood vessels. […] In stereotactic radiosurgery, precisely focused radiation blocks the irregular connection in the blood vessels. This causes blood vessels in the fistula to close off, destroying the dAVF. […] If an endovascular procedure or stereotactic radiosurgery aren’t options for you, you may need dAVF surgery. Surgery may be performed to disconnect the dAVF or cut off the blood supply and remove the fistula.

• #7 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. Both transarterial and transvenous approaches are used to cure dAVF. […] Surgery and, to a lesser extent, stereotactic radiosurgery are used when endovascular approaches are impossible or unsuccessful. […] Because of the benign nature, dAVFs without CVR (grades I and II) are often managed conservatively. Treatment can be palliative for patients who suffer from incapacitant tinnitus, ocular symptoms or severe headache. […] Various treatment modalities are used to manage aggressive dAVFs, including endovascular techniques, surgery, radiosurgery or a combination of these treatments. […] Endovascular approach is the first-line treatment for most dAVFs.

• #8 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. Both transarterial and transvenous approaches are used to cure dAVF. […] Surgery and, to a lesser extent, stereotactic radiosurgery are used when endovascular approaches are impossible or unsuccessful. […] Because of the benign nature, dAVFs without CVR (grades I and II) are often managed conservatively. Treatment can be palliative for patients who suffer from incapacitant tinnitus, ocular symptoms or severe headache. […] Various treatment modalities are used to manage aggressive dAVFs, including endovascular techniques, surgery, radiosurgery or a combination of these treatments. […] Endovascular approach is the first-line treatment for most dAVFs.

• #9 Dural Arteriovenous Fistula | Barrow Neurological InstituteSecond Opinion IconGroup 49Group 49

  https://www.barrowneuro.org/condition/dural-arteriovenous-fistula-davf/

  Treatment depends on the drainage pattern of the dural arteriovenous fistula and your symptoms. […] Most DAVFs can be cured with endovascular embolization, a minimally invasive procedure in which a catheter is threaded through the arteries and veins of either your wrist or leg to the site of the fistula. The fistula is then plugged with a material such as glue, a metal coil, or a balloon to correct the abnormal pattern of blood flow. […] For some DAVFs, microneurosurgery may be recommended instead of or in addition to endovascular embolization, though these cases are rare. […] Yes, the most common means of treating—and curing—a DAVF is through endovascular embolization. Open brain surgery rarely is required to treat a DAVF.

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

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

  Mayo Clinic neurosurgeons review surgical options for a dural arteriovenous fistula. […] Treatment for a dural arteriovenous fistula (dAVF) involves a procedure to block or disconnect the fistula. […] Procedures that can treat dAVF include: […] In an endovascular procedure, a long, thin tube called a catheter is inserted into a blood vessel in your leg or groin. It is threaded through blood vessels to the dural arteriovenous fistula using X-ray imaging. Coils or a glue-like substance is released to block the connection in the blood vessels. […] In stereotactic radiosurgery, precisely focused radiation blocks the irregular connection in the blood vessels. This causes blood vessels in the fistula to close off, destroying the dAVF. […] If an endovascular procedure or stereotactic radiosurgery aren’t options for you, you may need dAVF surgery. Surgery may be performed to disconnect the dAVF or cut off the blood supply and remove the fistula.

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

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

  A dural arteriovenous fistula (dAVF) is an abnormal connection between an artery and vein within the protective tissue that surrounds your brain and spinal cord. […] Your healthcare provider will determine the best treatment plan for you. […] Treatment can remove the fistula and improve blood flow in your blood vessels as expected. It can reduce and prevent new symptoms and complications from happening. […] The goal of dural arteriovenous fistula treatment is to remove the abnormal connection (fistula) between your artery and vein. Treatment options could include: […] Surgery: Open surgery can remove the fistula (abnormal connection) of the affected blood vessel. […] Endovascular embolization: This procedure uses a tiny tube, called a catheter, in your artery to reach the affected area and seal off the fistula.

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

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

  Transarterial approaches are often done under general anaesthesia with motor paralysis to decrease patient motion. […] In transarterial approaches, microcatheters are tracked over microwires to distal locations in feeding arteries, with the goal of getting the microcatheter as close to the fistula connection as possible. […] A transarterial approach is the preferred treatment for high-grade dAVFs with direct cortical venous drainage or in cases in which transvenous approach is limited. […] While flow-diverting stents have been used to treat direct CCFs, there is limited efficacy for treatment of the most common dAVF because of lesion complexity including multiple arterial feeders origins. […] Before the Onyx era, transvenous approach was the mainstay of endovascular treatment for cure of dAVF given that transarterial embolisation was successful only in about 50% of cases.

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

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

  Transvenous approach is preferred when a dAVF is supplied by small tortuous arteries excluding safe transarterial access to fistulous part. […] While transvenous Onyx embolisation is reported in small case series of dAVFs it is the mainstay of treatment for indirect CCF. […] Stereotactic radiosurgery (SRS) is usually reserved as a last salvage option for treatment of dAVF. […] While endovascular techniques are often considered first-line therapy for treatment of dAVFs, surgery remains an alternate effective and safe option.

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

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

  Transarterial approaches are often done under general anaesthesia with motor paralysis to decrease patient motion. […] In transarterial approaches, microcatheters are tracked over microwires to distal locations in feeding arteries, with the goal of getting the microcatheter as close to the fistula connection as possible. […] A transarterial approach is the preferred treatment for high-grade dAVFs with direct cortical venous drainage or in cases in which transvenous approach is limited. […] While flow-diverting stents have been used to treat direct CCFs, there is limited efficacy for treatment of the most common dAVF because of lesion complexity including multiple arterial feeders origins. […] Before the Onyx era, transvenous approach was the mainstay of endovascular treatment for cure of dAVF given that transarterial embolisation was successful only in about 50% of cases.

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

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

  Transarterial approaches are often done under general anaesthesia with motor paralysis to decrease patient motion. […] In transarterial approaches, microcatheters are tracked over microwires to distal locations in feeding arteries, with the goal of getting the microcatheter as close to the fistula connection as possible. […] A transarterial approach is the preferred treatment for high-grade dAVFs with direct cortical venous drainage or in cases in which transvenous approach is limited. […] While flow-diverting stents have been used to treat direct CCFs, there is limited efficacy for treatment of the most common dAVF because of lesion complexity including multiple arterial feeders origins. […] Before the Onyx era, transvenous approach was the mainstay of endovascular treatment for cure of dAVF given that transarterial embolisation was successful only in about 50% of cases.

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

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

  Transarterial approaches are often done under general anaesthesia with motor paralysis to decrease patient motion. […] In transarterial approaches, microcatheters are tracked over microwires to distal locations in feeding arteries, with the goal of getting the microcatheter as close to the fistula connection as possible. […] A transarterial approach is the preferred treatment for high-grade dAVFs with direct cortical venous drainage or in cases in which transvenous approach is limited. […] While flow-diverting stents have been used to treat direct CCFs, there is limited efficacy for treatment of the most common dAVF because of lesion complexity including multiple arterial feeders origins. […] Before the Onyx era, transvenous approach was the mainstay of endovascular treatment for cure of dAVF given that transarterial embolisation was successful only in about 50% of cases.

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

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

  Transvenous approach is preferred when a dAVF is supplied by small tortuous arteries excluding safe transarterial access to fistulous part. […] While transvenous Onyx embolisation is reported in small case series of dAVFs it is the mainstay of treatment for indirect CCF. […] Stereotactic radiosurgery (SRS) is usually reserved as a last salvage option for treatment of dAVF. […] While endovascular techniques are often considered first-line therapy for treatment of dAVFs, surgery remains an alternate effective and safe option.

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

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

  Transarterial approaches are often done under general anaesthesia with motor paralysis to decrease patient motion. […] In transarterial approaches, microcatheters are tracked over microwires to distal locations in feeding arteries, with the goal of getting the microcatheter as close to the fistula connection as possible. […] A transarterial approach is the preferred treatment for high-grade dAVFs with direct cortical venous drainage or in cases in which transvenous approach is limited. […] While flow-diverting stents have been used to treat direct CCFs, there is limited efficacy for treatment of the most common dAVF because of lesion complexity including multiple arterial feeders origins. […] Before the Onyx era, transvenous approach was the mainstay of endovascular treatment for cure of dAVF given that transarterial embolisation was successful only in about 50% of cases.

• #19

  https://link.springer.com/article/10.1007/s00062-021-01107-0

  Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. […] A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. […] The preferred approach in literature is the transvenous embolization of the CS affected by the fistula. […] In general, the endovascular approach demonstrated a high percentage of radiological (79.5%) and clinical (85%) resolution of the fistula, and a low complication rate (8%), with an almost negligible incidence of permanent deficit. […] A transvenous coiling is the most used endovascular treatment, achieving a high percentage of radiological and clinical resolution with a very low complication rate. In general, transvenous treatments showed less complications than transarterial approaches, and coil occlusion appeared safer than using liquid embolic agents.

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

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

  Mayo Clinic neurosurgeons review surgical options for a dural arteriovenous fistula. […] Treatment for a dural arteriovenous fistula (dAVF) involves a procedure to block or disconnect the fistula. […] Procedures that can treat dAVF include: […] In an endovascular procedure, a long, thin tube called a catheter is inserted into a blood vessel in your leg or groin. It is threaded through blood vessels to the dural arteriovenous fistula using X-ray imaging. Coils or a glue-like substance is released to block the connection in the blood vessels. […] In stereotactic radiosurgery, precisely focused radiation blocks the irregular connection in the blood vessels. This causes blood vessels in the fistula to close off, destroying the dAVF. […] If an endovascular procedure or stereotactic radiosurgery aren’t options for you, you may need dAVF surgery. Surgery may be performed to disconnect the dAVF or cut off the blood supply and remove the fistula.

• #21 Dural Arteriovenous Fistula Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/dural-arteriovenous-fistula

  A dural arteriovenous fistula (DAVF), also called a dural arteriovenous malformation (dural AVM), is an atypical connection between blood vessels in the dura. When necessary, surgical treatment for DAVF most commonly takes the form of endovascular embolization, microsurgical resection, or stereotactic radiosurgery. […] Dural arteriovenous fistulas are complex lesions and should be managed at major centers with specialists highly trained in their treatment. At Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, our neurosurgeons are experienced in evaluating DAVFs and in treating them surgically when necessary. […] The current treatment of choice for other DAVFs is endovascular embolization. To perform this procedure, a specialist inserts a catheter through an artery in the groin and then guides the catheter through the circulatory system to the site of the DAVF. Once in position, the catheter delivers a kind of glue. The glue embolizes the abnormal passageway, blocking the abnormal connection often permanently curing the fistula.

• #22 Dural arteriovenous fistula (DAVF) Symptoms and Treatment

  https://neuroandvascular.com/blog/dural-arteriovenous-fistula-davf-symptoms-and-treatment/

  Dural arteriovenous fistula (DAVF) Symptoms Treatment […] Endovascular embolization is a minimally invasive procedure commonly used to treat dural arteriovenous fistulas. Its the first line of treatment in most dural AVFs. […] […] Embolization of a DAVF is performed under general anesthesia. A catheter is inserted into an artery (usually the femoral artery in the front of the hip in the thigh) to perform this treatment. The small tube-like structure or catheter is taken into the fistula location, guided by fluoroscopic or X-ray imaging. A contrast/dye is injected to help in seeing the AVFs exact location. Then an embolizing or blocking material is injected into the exact spot where the artery and vein meet to block the fistula. The most commonly used embolization material is a peculiar agent called Onyx. The AVF is cured after the connection between the artery and the vein is closed, and it rarely recurs.

• #23 Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas with Cortical Venous Drainage: New Management Using Onyx | American Journal of Neuroradiology

  https://www.ajnr.org/content/29/2/235

  BACKGROUND AND PURPOSE: DAVFs (dural arteriovenous fistulas) represent one of the most dangerous types of intracranial AV shunts. Most of them are cured by arterial or venous embolization, but surgery/radiosurgery can be required in case of failure. Our goal was to reconsider the endovascular treatment strategy according to the new possibilities of arterial embolization using non polymerizing liquid embolic agent. […] Based on this experience, we believe that Onyx may be the treatment of choice for many patients with intracranial dural arteriovenous fistula (ICDAVF) with direct cortical venous reflux (CVR). The applicability of this new embolic agent indicates the need for reconsideration of the global treatment strategy for such fistulas. […] The present study examined the use of Onyx for endovascular treatment of ICDAVF with CVR. The study found that Onyx injections were easier to control than n-BCA injections, a much larger volume could be injected over a longer time period, injection in a single feeder allowed obtaining arterio-arterial reflux and avoided embolization of other feeders, and access through the meningeal artery was more efficient even if the size was very small.

• #24 Endovascular treatment for dural arteriovenous fistulas in the petroclival region

  https://www.medsci.org/v17p3020.htm

  The goal of EVT is complete obliteration of the lesion. To achieve definite obliteration via EVT, the embolic material has to plug the arteriovenous communication or seal the lumen of the draining venous structure. […] Complete embolization is necessary. Though partial EVT can result in marked decrease in flow and venous hypertension, the risk of rebleeding remains unchanged. […] Currently, as a result of the development of new techniques and materials, particularly with the use of Onyx (Medtronic Neurovascular, Minneapolis, MN), TAE has become a more effective option and represents the first-line option for many DAVFs. […] Currently, TVE is useful for intracranial DAVFs involving the major dural sinuses. However, TVE for petroclival region DAVFs is difficult because the initial venous drainage mainly flows through the pial veins. […] In summary, EVT cannot be readily used for all petroclival region DAVFs. When the arterial feeders are large or the DAVFs are adjacent to the venous sinuses, the success rate is high.

• #25 Treatment Study of Intracranial Dural Arteriovenous Fistulas | Rush

  https://www.rush.edu/clinical-trials/treatment-study-intracranial-dural-arteriovenous-fistulas

  This study is a prospective, multicenter, single-arm study. Patients with dural arteriovenous fistulas (dAVF) have a few choices for safe treatment. […] In this study, all patients with qualifying dAVFs will be treated with PHIL Liquid Embolic material.

• #26 Endovascular Treatment of Intracranial Dural Arteriovenous Fistulas with Cortical Venous Drainage: New Management Using Onyx | American Journal of Neuroradiology

  https://www.ajnr.org/content/29/2/235

  It appears that Onyx can be used as a primary treatment option for most cases of ICDAVF with direct CVR. This new agent provides an alternative to surgery for treatment of anterior skull base fistulas. In cases of a DAVF draining into a sinus with secondary CVR, Onyx arterial embolization may be performed as an alternative to retrograde venous catheterization. In conclusion, the technological options provided by this new embolic agent encourage a reconsideration of the global treatment strategy for DAVF with CVR.

• #27 Current status of endovascular treatment for dural arteriovenous fistula of the transverse-sigmoid sinus: A literature review

  https://www.medsci.org/v15p1600.htm

  The treatments for TSS DAVFs included TAE, TVE and a combination of both. […] Currently, TAE is extensively used, especially after the introduction of the latest embolizing material, Onyx, which can be controllably delivered into the fistula. […] For TSS DAVFs, TVE is a more effective treatment; moreover, the combination of TAE and TVE is also useful. […] During the EVT, the SPs play an important role. After the microcatheter accesses the SPs, TSS DAVFs can be successfully treated with the selective embolization of the SPs by TAE or TVE. […] The treatment of TSS DAVFs should be based on the angioarchitecture and cortical venous reflux. […] Grade 3 TSS DAVFs can be treated with TVE, and the affected sinus and retrograde cortical drainage outlet should be tightly packed with coils.

• #28 Treatment strategy to maximize the treatment outcome of spinal dural arteriovenous fistula after initial endovascular embolization attempt at diagnostic angiography | Scientific Reports

  https://www.nature.com/articles/s41598-021-89407-w

  Initial attempt of endovascular treatment (EVT) for spinal dural arteriovenous fistula (SDAVF) is preferred because of concurrent diagnosis and treatment. […] We retrospectively reviewed 71 patients with SDAVF to evaluate treatment outcomes of SDAVF after an initial EVT attempt. […] Complete occlusion was achieved by initial EVT in 37 of 56 patients (66.1%). […] Among 19 patients with incomplete occlusion upon initial EVT, 14 underwent additional surgery, 13 of whom (92.9%) obtained improved or stationary functional outcomes. […] Additional surgery achieved improved functional outcomes in cases of incomplete occlusion of SDAVF after the initial EVT attempt or recurrence rather than repeated EVT or follow-up. […] Although the surgical outcome of spinal dural arteriovenous fistula (SDAVF) is excellent, with a success rate over 95%, initial attempt of endovascular treatment (EVT) at the same session of diagnostic spinal angiography for spinal dural arteriovenous fistula (SDAVF) has become a preferred approach because of the benefit from concurrent diagnosis and treatment with a 70-90% rate of complete obliteration.

• #29 Cerebral Dural Arteriovenous Fistulas—an Update on Pathophysiology, Natural History and Treatment | [current-page:pager]touchNEUROLOGY

  https://touchneurology.com/surgery/journal-articles/cerebral-dural-arteriovenous-fistulas-an-update-on-pathophysiology-natural-history-and-treatment/

  Overall clinical and angiographic results for embolization are excellent for well selected fistulas. In one series of 260 cases treated endovascularly, 80% was a good predictor for angiographic obliteration of non-ethmoidal fistulas in the Onyx era, the rate of clinical improvement/resolution of pulsatile tinnitus when present, and the rate of clinical improvement/resolution of ocular symptoms when present. […] High risk fistulas whose shunt sites cannot be occluded by endovascular means can be treated by identifying the draining leptomeningeal vein exiting the dura and disconnecting it surgically. […] Low risk fistulas with tolerable symptoms or those that cannot be occluded endovascularly may be treated with radiosurgery.

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

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

  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. […] Of the 26 patients (M:F=7:19) who were managed by endovascular embolization of the dAVF, PT disappeared completely in 21 (80.8%), was abated substantially in 3 (11.5%), and remained the same in 2 (7.7%), resulting in a subjective symptom improvement rate of 92.3%. […] No major complications occurred after endovascular treatment. […] General approaches for the management of dAVFs include conservative treatment, endovascular intervention, surgery, and radiosurgery. […] Due to the recent efficacy of endovascular therapy, microsurgical obliteration is often reserved for cases in which endovascular embolization has failed or is not feasible.

• #31 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 (DAVFs) treatment includes different options: conservative, endovascular (trans-arterial or trans-venous embolization), surgical or stereotactic radiosurgery approaches. Venous drainage patterns and the risk of an aggressive clinical presentation, as well as presenting symptoms, and their impact on quality of life, determine the choice of the most appropriate treatment. […] A conservative approach was chosen in 6 (14.3%) out of the 42 DAVFs, 24 patients (66.6%) were treated by trans-arterial approach, while 12 (33.3%) were treated by trans-venous approach. Based upon the post-embolization angiographic assessment, the treatment resulted in a complete occlusion of the DAVF in 66.7% of cases. Major peri-procedural complications did not occur.

• #32 Long-term treatment outcomes and natural course of low-grade intracranial dural arteriovenous fistulas in: Neurosurgical Focus Volume 56 Issue 3 (2024) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/56/3/article-pE2.xml

  Treatment of low-grade dAVF provides a high rate of symptom relief with small risks for complications with neurological sequela. […] The risks of ICH and mortality in patients with untreated low-grade dAVF are minimal. […] Treatment, by means of embolization, surgery, stereotactic radiosurgery, or a combination of these, has been shown to be highly effective in terms of dAVF occlusion and symptom relief. […] We showed that EVT of low-grade dAVF achieves a high rate of symptom relief (98%), with a low risk of permanent neurological deficit (2%). […] The overall complication rate of our study is similar to that of a previous report (21%), but the vast majority of the complications were without neurological sequela. […] Given the benign nature of low-grade dAVF, patient counseling regarding the risks linked to treatment is paramount. […] Still, in light of this and previous studies, treatment of low-grade dAVFs can be considered effective and safe.

• #33

  https://link.springer.com/article/10.1007/s00062-021-01107-0

  Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. […] A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. […] The preferred approach in literature is the transvenous embolization of the CS affected by the fistula. […] In general, the endovascular approach demonstrated a high percentage of radiological (79.5%) and clinical (85%) resolution of the fistula, and a low complication rate (8%), with an almost negligible incidence of permanent deficit. […] A transvenous coiling is the most used endovascular treatment, achieving a high percentage of radiological and clinical resolution with a very low complication rate. In general, transvenous treatments showed less complications than transarterial approaches, and coil occlusion appeared safer than using liquid embolic agents.

• #34 Long-term treatment outcomes and natural course of low-grade intracranial dural arteriovenous fistulas in: Neurosurgical Focus Volume 56 Issue 3 (2024) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/56/3/article-pE2.xml

  Treatment of low-grade dAVF provides a high rate of symptom relief with small risks for complications with neurological sequela. […] The risks of ICH and mortality in patients with untreated low-grade dAVF are minimal. […] Treatment, by means of embolization, surgery, stereotactic radiosurgery, or a combination of these, has been shown to be highly effective in terms of dAVF occlusion and symptom relief. […] We showed that EVT of low-grade dAVF achieves a high rate of symptom relief (98%), with a low risk of permanent neurological deficit (2%). […] The overall complication rate of our study is similar to that of a previous report (21%), but the vast majority of the complications were without neurological sequela. […] Given the benign nature of low-grade dAVF, patient counseling regarding the risks linked to treatment is paramount. […] Still, in light of this and previous studies, treatment of low-grade dAVFs can be considered effective and safe.

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

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

  The following are the popular 2 methods to treat DAVFs. Depending on the type of DAVF involved, a combination of the two methods can also be used: […] This technique is usually enough to treat various types of DAVFs. During this procedure, a catheter is passed through the groin up into the arteries that further lead to the brain. […] This technique is usually recommended for patients whose DAVFs cannot be closed with other techniques like endovascular embolisation. During the microsurgical resection procedure, a craniotomy is performed on the patient. […] 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.

• #36 Endovascular treatment for dural arteriovenous fistulas in the petroclival region

  https://www.medsci.org/v17p3020.htm

  The goal of EVT is complete obliteration of the lesion. To achieve definite obliteration via EVT, the embolic material has to plug the arteriovenous communication or seal the lumen of the draining venous structure. […] Complete embolization is necessary. Though partial EVT can result in marked decrease in flow and venous hypertension, the risk of rebleeding remains unchanged. […] Currently, as a result of the development of new techniques and materials, particularly with the use of Onyx (Medtronic Neurovascular, Minneapolis, MN), TAE has become a more effective option and represents the first-line option for many DAVFs. […] Currently, TVE is useful for intracranial DAVFs involving the major dural sinuses. However, TVE for petroclival region DAVFs is difficult because the initial venous drainage mainly flows through the pial veins. […] In summary, EVT cannot be readily used for all petroclival region DAVFs. When the arterial feeders are large or the DAVFs are adjacent to the venous sinuses, the success rate is high.

• #37 Treatment strategy to maximize the treatment outcome of spinal dural arteriovenous fistula after initial endovascular embolization attempt at diagnostic angiography | Scientific Reports

  https://www.nature.com/articles/s41598-021-89407-w

  In the case of incomplete occlusion by initial EVT, surgical treatment should be considered rather than additional EVT or a wait-and-see approach with the expectation of spontaneous thrombosis to achieve complete obliteration of the SDAVF and improved functional outcomes. […] Considering the lower rate of complete occlusion and higher probability of procedure-related complications of repeated EVT for cervical SDAVF, surgery should be considered instead of repeated EVT when cervical SDAVF is incompletely occluded by initial EVT.

• #38 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

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

  The decision of whether to treat dAVFs is based on the patient’s symptoms, medical comorbidities, and risk of intracranial hypertension or hemorrhage. Lesions that are asymptomatic and low-grade tend to have a benign natural history and are generally managed conservatively with serial monitoring.[10] […] Those that are high-grade with cortical venous drainage or symptomatic are candidates for an intervention. Open surgery, endovascular embolization, and stereotactic radiosurgery are the main options for intervention. The goal of treatment is to achieve a complete disconnection of the fistula from its venous drainage. Incomplete disconnection may allow for the recruitment of other arteries to the fistula and may not improve the risk of hemorrhage or symptoms.[12] […] Surgical treatment involves the surgical disconnection of the fistula from the cortical venous system. Occasionally, skeletonization of the dural sinus with disconnection of the dural arterial supply, packing of the sinus, or resection of the involved dura is performed. Surgery is usually indicated in cases in which endovascular approaches have failed or can not be performed. In addition, those involving the floor of the anterior cranial fossa are usually treated surgically.

• #39 Dural Arteriovenous Fistula Diagnosis & Treatment – NYC | Columbia Neurosurgery in New York City

  https://www.neurosurgery.columbia.edu/patient-care/conditions/dural-arteriovenous-fistula

  Sometimes microsurgical resection, in which a surgeon completely removes the abnormal vessels, is necessary. When possible, the DAVF lesion is embolized before it is removed. But in cases in which the risk of hemorrhage is high, or in which the catheter cannot reach the DAVF, microsurgical resection may be used alone. […] Stereotactic radiosurgery also may be used in specific cases.

• #40 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

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

  The decision of whether to treat dAVFs is based on the patient’s symptoms, medical comorbidities, and risk of intracranial hypertension or hemorrhage. Lesions that are asymptomatic and low-grade tend to have a benign natural history and are generally managed conservatively with serial monitoring.[10] […] Those that are high-grade with cortical venous drainage or symptomatic are candidates for an intervention. Open surgery, endovascular embolization, and stereotactic radiosurgery are the main options for intervention. The goal of treatment is to achieve a complete disconnection of the fistula from its venous drainage. Incomplete disconnection may allow for the recruitment of other arteries to the fistula and may not improve the risk of hemorrhage or symptoms.[12] […] Surgical treatment involves the surgical disconnection of the fistula from the cortical venous system. Occasionally, skeletonization of the dural sinus with disconnection of the dural arterial supply, packing of the sinus, or resection of the involved dura is performed. Surgery is usually indicated in cases in which endovascular approaches have failed or can not be performed. In addition, those involving the floor of the anterior cranial fossa are usually treated surgically.

• #41 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

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

  The decision of whether to treat dAVFs is based on the patient’s symptoms, medical comorbidities, and risk of intracranial hypertension or hemorrhage. Lesions that are asymptomatic and low-grade tend to have a benign natural history and are generally managed conservatively with serial monitoring.[10] […] Those that are high-grade with cortical venous drainage or symptomatic are candidates for an intervention. Open surgery, endovascular embolization, and stereotactic radiosurgery are the main options for intervention. The goal of treatment is to achieve a complete disconnection of the fistula from its venous drainage. Incomplete disconnection may allow for the recruitment of other arteries to the fistula and may not improve the risk of hemorrhage or symptoms.[12] […] Surgical treatment involves the surgical disconnection of the fistula from the cortical venous system. Occasionally, skeletonization of the dural sinus with disconnection of the dural arterial supply, packing of the sinus, or resection of the involved dura is performed. Surgery is usually indicated in cases in which endovascular approaches have failed or can not be performed. In addition, those involving the floor of the anterior cranial fossa are usually treated surgically.

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

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

  Mayo Clinic neurosurgeons review surgical options for a dural arteriovenous fistula. […] Treatment for a dural arteriovenous fistula (dAVF) involves a procedure to block or disconnect the fistula. […] Procedures that can treat dAVF include: […] In an endovascular procedure, a long, thin tube called a catheter is inserted into a blood vessel in your leg or groin. It is threaded through blood vessels to the dural arteriovenous fistula using X-ray imaging. Coils or a glue-like substance is released to block the connection in the blood vessels. […] In stereotactic radiosurgery, precisely focused radiation blocks the irregular connection in the blood vessels. This causes blood vessels in the fistula to close off, destroying the dAVF. […] If an endovascular procedure or stereotactic radiosurgery aren’t options for you, you may need dAVF surgery. Surgery may be performed to disconnect the dAVF or cut off the blood supply and remove the fistula.

• #43 Treatment and outcome of spinal dural arteriovenous fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3467794/

  Spinal dural arteriovenous fistula (dAVFs) are rare and often misdiagnosed entities. The choice between surgical treatment and embolization remains a matter of debate. […] An attempt at embolization should be made following diagnostic angiography. Otherwise, surgery is our recommended treatment for spinal dural fistulas, as it has a lower failure rate. Because of the progressive natural course with severe deficits, we favor an early definitive treatment. […] The surgical treatment consists of intradural interruption of the draining vein with coagulation or excision of the dural fistula. Alternatively, endovascular treatment with liquid embolic material is possible. […] The usual operative procedure of dural fistulas consisted of a limited hemilaminectomy at the side of the draining vein, excision or clipping of the fistula, no stripping of veins, and an intraoperative Doppler control to demonstrate the elimination of the pathological AV communication.

• #44 Treatment and outcome of spinal dural arteriovenous fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3467794/

  Spinal dural arteriovenous fistula (dAVFs) are rare and often misdiagnosed entities. The choice between surgical treatment and embolization remains a matter of debate. […] An attempt at embolization should be made following diagnostic angiography. Otherwise, surgery is our recommended treatment for spinal dural fistulas, as it has a lower failure rate. Because of the progressive natural course with severe deficits, we favor an early definitive treatment. […] The surgical treatment consists of intradural interruption of the draining vein with coagulation or excision of the dural fistula. Alternatively, endovascular treatment with liquid embolic material is possible. […] The usual operative procedure of dural fistulas consisted of a limited hemilaminectomy at the side of the draining vein, excision or clipping of the fistula, no stripping of veins, and an intraoperative Doppler control to demonstrate the elimination of the pathological AV communication.

• #45 Spinal dural arteriovenous fistula: a comprehensive review of the history, classification systems, management, and prognosis | Chinese Neurosurgical Journal | Full Text

  https://cnjournal.biomedcentral.com/articles/10.1186/s41016-023-00355-y

  Spinal dural arteriovenous fistulas can be suspected on magnetic resonance imaging/magnetic resonance angiography and confirmed by digital subtraction angiography (DSA). The management includes surgery, endovascular therapy, and in selected cases, radiotherapy. The treatment goal of spinal dural arteriovenous fistula is to halt the progression of the disease. […] Surgical occlusion is considered the mainstay, most definitive, and curative treatment modality for spinal dural arteriovenous fistula, due to its safety, effectiveness, and improvement of neurologic symptoms in most patients. […] Steinmetz and collaborators recommended surgical treatment as the first-line therapy in dealing with spinal dural arteriovenous fistula, because it has a successful occlusion rate of 98%, with 2% morbidity and no mortality.

• #46 Surgical treatment of Type I spinal dural arteriovenous fistulas in: Neurosurgical Focus Volume 32 Issue 5 (2012) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/32/5/2012.1.focus11344.xml

  Type I spinal dural arteriovenous fistulas (SDAVFs) are low-flow vascular shunts fed by radicular arteries in patients who most often present with myelopathy. Although some fistulas are amenable to endovascular embolization, nearly all can be treated with direct microsurgical obliteration. […] In all patients who underwent microsurgical treatment, complete angiographic obliteration of the fistula was achieved. […] Microsurgical treatment of SDAVF provides direct access to the fistula point, allowing for high obliteration rates with excellent long-term improvement of preoperative deficits and limited periprocedural complications. […] Although some groups advocate endovascular therapy, we most often employ microsurgical obliteration as the first-line treatment option, given the ability to reliably visualize and gain direct access to the fistula point.

• #47 Spinal dural arteriovenous fistula: a comprehensive review of the history, classification systems, management, and prognosis | Chinese Neurosurgical Journal | Full Text

  https://cnjournal.biomedcentral.com/articles/10.1186/s41016-023-00355-y

  Spinal dural arteriovenous fistulas can be suspected on magnetic resonance imaging/magnetic resonance angiography and confirmed by digital subtraction angiography (DSA). The management includes surgery, endovascular therapy, and in selected cases, radiotherapy. The treatment goal of spinal dural arteriovenous fistula is to halt the progression of the disease. […] Surgical occlusion is considered the mainstay, most definitive, and curative treatment modality for spinal dural arteriovenous fistula, due to its safety, effectiveness, and improvement of neurologic symptoms in most patients. […] Steinmetz and collaborators recommended surgical treatment as the first-line therapy in dealing with spinal dural arteriovenous fistula, because it has a successful occlusion rate of 98%, with 2% morbidity and no mortality.

• #48 Spinal dural arteriovenous fistula: a comprehensive review of the history, classification systems, management, and prognosis | Chinese Neurosurgical Journal | Full Text

  https://cnjournal.biomedcentral.com/articles/10.1186/s41016-023-00355-y

  In 1968, the first embolization of spinal dural arteriovenous fistula was performed by Doppman et al. Currently, endovascular treatment is often offered as a first-line therapy of dural arteriovenous fistulas of the spine. […] Based on the largest and most recently reported multicenter cohort study, which was published in 2020, surgery is superior to endovascular treatment for the complete obliteration of spinal dural arteriovenous fistulas. […] Although the literature described a case of a spinal dural arteriovenous fistula which was treated successfully with stereotactic radiosurgery, until this time, it is not considered an established treatment option for such lesions, and reports regarding the use of stereotactic radiosurgery in these cases are very limited.

• #49 Spinal dural arteriovenous fistula: a comprehensive review of the history, classification systems, management, and prognosis | Chinese Neurosurgical Journal | Full Text

  https://cnjournal.biomedcentral.com/articles/10.1186/s41016-023-00355-y

  Spinal dural arteriovenous fistulas can be suspected on magnetic resonance imaging/magnetic resonance angiography and confirmed by digital subtraction angiography (DSA). The management includes surgery, endovascular therapy, and in selected cases, radiotherapy. The treatment goal of spinal dural arteriovenous fistula is to halt the progression of the disease. […] Surgical occlusion is considered the mainstay, most definitive, and curative treatment modality for spinal dural arteriovenous fistula, due to its safety, effectiveness, and improvement of neurologic symptoms in most patients. […] Steinmetz and collaborators recommended surgical treatment as the first-line therapy in dealing with spinal dural arteriovenous fistula, because it has a successful occlusion rate of 98%, with 2% morbidity and no mortality.

• #50 Surgical treatment of Type I spinal dural arteriovenous fistulas in: Neurosurgical Focus Volume 32 Issue 5 (2012) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/32/5/2012.1.focus11344.xml

  In our series, all patients had favorable outcomes—either long-term improvement or stability of preoperative symptoms. […] Patients with Type I SDAVFs warrant prompt treatment due to the progressive nature of their disease. Providing direct access to the fistula point, microsurgical treatment can be performed with exceedingly high obliteration rates and long-term postoperative improvement of preexisting deficits in the majority of cases.

• #51 Surgical treatment of Type I spinal dural arteriovenous fistulas in: Neurosurgical Focus Volume 32 Issue 5 (2012) Journals

  https://thejns.org/focus/view/journals/neurosurg-focus/32/5/2012.1.focus11344.xml

  In our series, all patients had favorable outcomes—either long-term improvement or stability of preoperative symptoms. […] Patients with Type I SDAVFs warrant prompt treatment due to the progressive nature of their disease. Providing direct access to the fistula point, microsurgical treatment can be performed with exceedingly high obliteration rates and long-term postoperative improvement of preexisting deficits in the majority of cases.

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

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

  Mayo Clinic neurosurgeons review surgical options for a dural arteriovenous fistula. […] Treatment for a dural arteriovenous fistula (dAVF) involves a procedure to block or disconnect the fistula. […] Procedures that can treat dAVF include: […] In an endovascular procedure, a long, thin tube called a catheter is inserted into a blood vessel in your leg or groin. It is threaded through blood vessels to the dural arteriovenous fistula using X-ray imaging. Coils or a glue-like substance is released to block the connection in the blood vessels. […] In stereotactic radiosurgery, precisely focused radiation blocks the irregular connection in the blood vessels. This causes blood vessels in the fistula to close off, destroying the dAVF. […] If an endovascular procedure or stereotactic radiosurgery aren’t options for you, you may need dAVF surgery. Surgery may be performed to disconnect the dAVF or cut off the blood supply and remove the fistula.

• #53 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

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

  Endovascular surgery using embolic material or coil occlusion can involve transvenous, trans-arterial, direct access, or a combination of techniques to block the abnormal connection in the blood vessels.[12] The treatment is aimed at the complete elimination of the arteriovenous shunt. This can be performed transarterial or transvenous. […] Stereotactic radiosurgery achieves excellent rates of obliteration for low-grade lesions but is less effective for higher-grade lesions. Radiosurgery is most often utilized for low-grade (Borden type I) dAVFs with persistent symptoms such as pulsatile tinnitus. It can also be used for dAVFs with unfavorable anatomy for other interventions, patients with significant medical comorbidities, or as salvage therapy for lesions incompletely treated with surgery or endovascular embolization.[12][13] The area is irradiated with 2030 Gy, which causes vessel thrombosis and fistula closure. The end result takes several months to various years with a risk of hemorrhage until final obliteration.

• #54 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

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

  Endovascular surgery using embolic material or coil occlusion can involve transvenous, trans-arterial, direct access, or a combination of techniques to block the abnormal connection in the blood vessels.[12] The treatment is aimed at the complete elimination of the arteriovenous shunt. This can be performed transarterial or transvenous. […] Stereotactic radiosurgery achieves excellent rates of obliteration for low-grade lesions but is less effective for higher-grade lesions. Radiosurgery is most often utilized for low-grade (Borden type I) dAVFs with persistent symptoms such as pulsatile tinnitus. It can also be used for dAVFs with unfavorable anatomy for other interventions, patients with significant medical comorbidities, or as salvage therapy for lesions incompletely treated with surgery or endovascular embolization.[12][13] The area is irradiated with 2030 Gy, which causes vessel thrombosis and fistula closure. The end result takes several months to various years with a risk of hemorrhage until final obliteration.

• #55 Arteriovenous Fistula (DAVF) Treatment Options | UNC Rex

  https://www.ncneurospine.com/neuroscience-medical-services/neuroendovascular/arteriovenous-fistula-davf/

  Stereotactic radiosurgery is a technique that employs precisely focused radiation to disrupt the abnormal connection within the blood vessels. High doses of radiation are directed at the fistula, prompting the closure of blood vessels and ultimately eradicating the dAVF. Various technologies can be utilized for dAVF stereotactic radiosurgery, including the linear accelerator (LINAC), Gamma Knife, and proton beam therapy. […] If endovascular procedures or stereotactic radiosurgery are not feasible or suitable for your condition, dAVF surgery may be necessary. During this surgical intervention, the dAVF can either be disconnected or its blood supply severed and the fistula removed. […] The choice of treatment modality depends on the specific characteristics of the dAVF and your individual medical circumstances, with the goal of eliminating the abnormal connection and preventing associated complications.

• #56 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

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

  Endovascular surgery using embolic material or coil occlusion can involve transvenous, trans-arterial, direct access, or a combination of techniques to block the abnormal connection in the blood vessels.[12] The treatment is aimed at the complete elimination of the arteriovenous shunt. This can be performed transarterial or transvenous. […] Stereotactic radiosurgery achieves excellent rates of obliteration for low-grade lesions but is less effective for higher-grade lesions. Radiosurgery is most often utilized for low-grade (Borden type I) dAVFs with persistent symptoms such as pulsatile tinnitus. It can also be used for dAVFs with unfavorable anatomy for other interventions, patients with significant medical comorbidities, or as salvage therapy for lesions incompletely treated with surgery or endovascular embolization.[12][13] The area is irradiated with 2030 Gy, which causes vessel thrombosis and fistula closure. The end result takes several months to various years with a risk of hemorrhage until final obliteration.

• #57 Dural Arteriovenous Fistula – StatPearls – NCBI Bookshelf

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

  Endovascular surgery using embolic material or coil occlusion can involve transvenous, trans-arterial, direct access, or a combination of techniques to block the abnormal connection in the blood vessels.[12] The treatment is aimed at the complete elimination of the arteriovenous shunt. This can be performed transarterial or transvenous. […] Stereotactic radiosurgery achieves excellent rates of obliteration for low-grade lesions but is less effective for higher-grade lesions. Radiosurgery is most often utilized for low-grade (Borden type I) dAVFs with persistent symptoms such as pulsatile tinnitus. It can also be used for dAVFs with unfavorable anatomy for other interventions, patients with significant medical comorbidities, or as salvage therapy for lesions incompletely treated with surgery or endovascular embolization.[12][13] The area is irradiated with 2030 Gy, which causes vessel thrombosis and fistula closure. The end result takes several months to various years with a risk of hemorrhage until final obliteration.

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

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

  Transvenous approach is preferred when a dAVF is supplied by small tortuous arteries excluding safe transarterial access to fistulous part. […] While transvenous Onyx embolisation is reported in small case series of dAVFs it is the mainstay of treatment for indirect CCF. […] Stereotactic radiosurgery (SRS) is usually reserved as a last salvage option for treatment of dAVF. […] While endovascular techniques are often considered first-line therapy for treatment of dAVFs, surgery remains an alternate effective and safe option.

• #59 Spinal dural arteriovenous fistula: a comprehensive review of the history, classification systems, management, and prognosis | Chinese Neurosurgical Journal | Full Text

  https://cnjournal.biomedcentral.com/articles/10.1186/s41016-023-00355-y

  In 1968, the first embolization of spinal dural arteriovenous fistula was performed by Doppman et al. Currently, endovascular treatment is often offered as a first-line therapy of dural arteriovenous fistulas of the spine. […] Based on the largest and most recently reported multicenter cohort study, which was published in 2020, surgery is superior to endovascular treatment for the complete obliteration of spinal dural arteriovenous fistulas. […] Although the literature described a case of a spinal dural arteriovenous fistula which was treated successfully with stereotactic radiosurgery, until this time, it is not considered an established treatment option for such lesions, and reports regarding the use of stereotactic radiosurgery in these cases are very limited.

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

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

  It is important to tailor management of DAVF to each patient. Specific goals should be put forward taking into account the natural history of the lesion (which mainly depends on its venous drainage pattern), its specific anatomical features and the patient’s symptoms. Most dural fistulas can be managed by endovascular means but some are more appropriately approached by surgery. Some difficult lesions need the judicious combination of endovascular techniques and surgery. […] Endovascular treatment was recommended to prevent recurrent hemorrhage. He underwent embolization and disconnection of the fistula. […] After an embolization treatment procedure, Dr. Abdalkader and Dr. Nguyen successfully and completely disconnected the fistula.

• #61

  https://link.springer.com/article/10.1007/s00701-021-04950-9

  Cranial dural arteriovenous fistulas (dAVFs) are rare lesions managed mainly with endovascular treatment (EVT) and/or surgery. […] We recommend EVT as first treatment modality in types I, II, and in non-hemorrhagic type III/IV dAVFs. […] We recommend surgery as first treatment choice in acute hemorrhagic dAVFs and as secondary choice in type III/IV dAVFs not successfully occluded by EVT. […] Combining the two modalities provides obliteration in 9/10 dAVF cases at a low procedural risk. […] The choice of treatment is based on presenting symptoms and the dAVF angioarchitecture. […] Although endovascular treatment (EVT) has become the primary treatment modality of most cranial dAVFs, surgery is used in various settings. […] The preferred surgical treatment of type III/IV dAVFs is disconnection of the leptomeningeal vein(s) where it (they) emerge(s) from the fistula, thereby ensuring all routes of venous outflow are obliterated.

• #62

  https://link.springer.com/article/10.1007/s00701-021-04950-9

  Cranial dural arteriovenous fistulas (dAVFs) are rare lesions managed mainly with endovascular treatment (EVT) and/or surgery. […] We recommend EVT as first treatment modality in types I, II, and in non-hemorrhagic type III/IV dAVFs. […] We recommend surgery as first treatment choice in acute hemorrhagic dAVFs and as secondary choice in type III/IV dAVFs not successfully occluded by EVT. […] Combining the two modalities provides obliteration in 9/10 dAVF cases at a low procedural risk. […] The choice of treatment is based on presenting symptoms and the dAVF angioarchitecture. […] Although endovascular treatment (EVT) has become the primary treatment modality of most cranial dAVFs, surgery is used in various settings. […] The preferred surgical treatment of type III/IV dAVFs is disconnection of the leptomeningeal vein(s) where it (they) emerge(s) from the fistula, thereby ensuring all routes of venous outflow are obliterated.

• #63 Dural Arteriovenous Fistula Treatment Sydney – CURA Medical SpecialistsCURA Specialists

  https://curaspecialists.com.au/conditions/dural-arteriovenous-fistula-treatment-sydney/

  We at CURA Medical Specialists are leading experts in the diagnosis and treatment of DAVFs. Whether youre suffering from low-risk or high-risk DAVFs, we will be able to provide you with a treatment plan for your individual needs to ensure you dont suffer from any further complications. […] What treatments for DAVF do our medical team at CURA offer? Minimally invasive endovascular embolisation and microsurgical resection are two conventional methods for DAVF treatment. One or a combination of the two methods can also be used. […] A catheter is passed through the groin into the arteries that lead to the brain. A liquid embolic agent, such as glue or Onyx is then injected into the affected arteries. This liquid helps to block the artery, reducing the flow of blood through the DAVF. This is the most common treatment and in most cases is enough to treat various types of DAVFs and prevent future risk of haemorrhage.

• #64 Dural arteriovenous fistulas | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/dural-arteriovenous-fistulas?content_id=CON-20309677

  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. […] Treatment for a dural arteriovenous fistula (dAVF) involves a procedure to block or disconnect the fistula. […] Procedures that can treat dAVF include: Endovascular procedures. In an endovascular procedure, a long, thin tube called a catheter is inserted into a blood vessel in your leg or groin. It is threaded through blood vessels to the dural arteriovenous fistula using X-ray imaging. Coils or a glue-like substance is released to block the connection in the blood vessels. […] Stereotactic radiosurgery. In stereotactic radiosurgery, precisely focused radiation blocks the irregular connection in the blood vessels. This causes blood vessels in the fistula to close off, destroying the dAVF. […] dAVF surgery. If an endovascular procedure or stereotactic radiosurgery aren’t options for you, you may need dAVF surgery. Surgery may be performed to disconnect the dAVF or cut off the blood supply and remove the fistula.

• #65 Treatment and outcome of spinal dural arteriovenous fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3467794/

  We prefer an operative excision, in order to exclude the collateral supply and to preserve the small radicular spinal cord feeders, which may originate close by from a common meningoradicular artery outside the dura. The unfavorable time course of the disease can be stopped and sometimes reversed with the operation. Treatment failure of embolization is still higher than that of surgery. However, embolization has the advantage of low general morbidity, and may be helpful in patients with reduced physical condition. The chance of complete cure following embolization with a permanent agent is considered to be inferior to surgery. In case of extensive collateral vessels or feeding vessels, the primary option is surgery. We also recommend surgery as the definitive treatment of dAVF in recurrent fistulas with collateralization from the opposite side or other levels. Otherwise, an attempt at embolization following diagnostic angiography should be made.

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

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

  Stereotactic radiosurgery: This is a form of radiation therapy that uses focused beams of radiation directed at the affected blood vessel to block off the fistula connection. […] 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. […] If you dont have symptoms, your healthcare provider may not immediately treat the condition but offer regular monitoring to prevent complications. […] Treatment is available to remove the fistula and improve blood flow to all parts of your body. There are different treatment options and not all require open surgery. Your care team will review your symptoms and determine the right treatment plan for you to prevent complications.

• #67 Lyerly | Neurosurgery | Dural Arteriovenous Fistulas

  https://www.baptistjax.com/doctors/lyerly-neurosurgery/stroke-and-cerebrovascular-care/understanding-dural-arteriovenous-fistulas

  If you’ve been diagnosed with a dural arteriovenous fistula, your doctor will create a treatment plan for you that is based on several factors, including the size and location of the DAVF (together with its potential for hemorrhage), whether there is evidence of past or current bleeding, the severity of your symptoms and your overall health. […] Treatment options for DAVF are designed to close the abnormal connection between its arteries and veins, and include: […] Endovascular embolization is a minimally invasive procedure that does not require open brain surgery. During the procedure, a neurosurgeon threads a small, flexible tube called a catheter through the arteries (often starting in the groin area) until it reaches an artery that „feeds” the DAVF with blood. Once the catheter is in place, the neurosurgeon injects one of several materials called embolizing agents these include tiny metal coils and glue-like substances to reduce or block blood flow into the DAVF.

• #68 Dural Arteriovenous Fistula – Interventional Neuroradiology | UCLA Health

  https://www.uclahealth.org/medical-services/radiology/interventional-neuroradiology/diseases-treated/dural-arteriovenous-fistula

  Most DAVF’s are thought to be an acquired disease. DAVF’s can be formed in the following conditions: dural sinus thrombosis (clotting and blockage of the dural sinuses), head injury, and open surgery. […] First step of the treatment is to obtain an entire picture of a DAVF and characterize it. Cerebral angiography (dye injection into brain arteries through a plastic tube) is the gold-standard and the most accurate way to do so. Based on the finding of cerebral angiography and the symptoms, the following options are offered: Endovascular embolization, Open surgery, Observation. […] One of the most worrisome finding is so called „cortical venous reflux”. This is the sign that blood flow return to the brain is compromised and associated with high risk of brain hemorrhage. Regardless of the symptoms, DAVF’s with cortical venous reflux should be treated as soon as practical by either endovascular embolization or open surgery. Recently, most DAVF’s can be treated by endovascular embolization. […] When a patient cannot tolerate the symptom such as pulsating noise, endovascular embolization is considered. Simple observation can be an option for some DAVF’s with negligible risk of hemorrhage.

• #69 Dural arteriovenous fistula – Wikipedia

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

  Treatment Arteriovenous fistula obliteration, including: embolization, surgery, radiosurgery. […] 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 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. […] Indications: Hemorrhage, Neurologic dysfunction or refractory symptoms. […] One approach used for treatment is embolization. […] DAVFs are also managed surgically. The operative approach varies depending on the location of the lesion. […] Stereotactic radiosurgery is used for obliterating DAVFs sometimes in conjunction with embolization or surgery, and is considered an important adjunct and sometimes a primary treatment method for non-aggressive DAVFs.

• #70 Dural Arteriovenous Fistula – Interventional Neuroradiology | UCLA Health

  https://www.uclahealth.org/medical-services/radiology/interventional-neuroradiology/diseases-treated/dural-arteriovenous-fistula

  Most DAVF’s are thought to be an acquired disease. DAVF’s can be formed in the following conditions: dural sinus thrombosis (clotting and blockage of the dural sinuses), head injury, and open surgery. […] First step of the treatment is to obtain an entire picture of a DAVF and characterize it. Cerebral angiography (dye injection into brain arteries through a plastic tube) is the gold-standard and the most accurate way to do so. Based on the finding of cerebral angiography and the symptoms, the following options are offered: Endovascular embolization, Open surgery, Observation. […] One of the most worrisome finding is so called „cortical venous reflux”. This is the sign that blood flow return to the brain is compromised and associated with high risk of brain hemorrhage. Regardless of the symptoms, DAVF’s with cortical venous reflux should be treated as soon as practical by either endovascular embolization or open surgery. Recently, most DAVF’s can be treated by endovascular embolization. […] When a patient cannot tolerate the symptom such as pulsating noise, endovascular embolization is considered. Simple observation can be an option for some DAVF’s with negligible risk of hemorrhage.

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

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

  Stereotactic radiosurgery: This is a form of radiation therapy that uses focused beams of radiation directed at the affected blood vessel to block off the fistula connection. […] 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. […] If you dont have symptoms, your healthcare provider may not immediately treat the condition but offer regular monitoring to prevent complications. […] Treatment is available to remove the fistula and improve blood flow to all parts of your body. There are different treatment options and not all require open surgery. Your care team will review your symptoms and determine the right treatment plan for you to prevent complications.

• #72 Dural Arteriovenous Fistula – Interventional Neuroradiology | UCLA Health

  https://www.uclahealth.org/medical-services/radiology/interventional-neuroradiology/diseases-treated/dural-arteriovenous-fistula

  Most DAVF’s are thought to be an acquired disease. DAVF’s can be formed in the following conditions: dural sinus thrombosis (clotting and blockage of the dural sinuses), head injury, and open surgery. […] First step of the treatment is to obtain an entire picture of a DAVF and characterize it. Cerebral angiography (dye injection into brain arteries through a plastic tube) is the gold-standard and the most accurate way to do so. Based on the finding of cerebral angiography and the symptoms, the following options are offered: Endovascular embolization, Open surgery, Observation. […] One of the most worrisome finding is so called „cortical venous reflux”. This is the sign that blood flow return to the brain is compromised and associated with high risk of brain hemorrhage. Regardless of the symptoms, DAVF’s with cortical venous reflux should be treated as soon as practical by either endovascular embolization or open surgery. Recently, most DAVF’s can be treated by endovascular embolization. […] When a patient cannot tolerate the symptom such as pulsating noise, endovascular embolization is considered. Simple observation can be an option for some DAVF’s with negligible risk of hemorrhage.

• #73

  https://link.springer.com/article/10.1007/s00701-021-04950-9

  Cranial dural arteriovenous fistulas (dAVFs) are rare lesions managed mainly with endovascular treatment (EVT) and/or surgery. […] We recommend EVT as first treatment modality in types I, II, and in non-hemorrhagic type III/IV dAVFs. […] We recommend surgery as first treatment choice in acute hemorrhagic dAVFs and as secondary choice in type III/IV dAVFs not successfully occluded by EVT. […] Combining the two modalities provides obliteration in 9/10 dAVF cases at a low procedural risk. […] The choice of treatment is based on presenting symptoms and the dAVF angioarchitecture. […] Although endovascular treatment (EVT) has become the primary treatment modality of most cranial dAVFs, surgery is used in various settings. […] The preferred surgical treatment of type III/IV dAVFs is disconnection of the leptomeningeal vein(s) where it (they) emerge(s) from the fistula, thereby ensuring all routes of venous outflow are obliterated.

• #74

  https://link.springer.com/article/10.1007/s00701-021-04950-9

  In type II dAVFs, one may perform dAVF excision with resection of the sinus and not just venous disconnection. […] The present experience of 21/23 (91%) of the hemorrhagic cases being asymptomatic prior to ictus, however, suggests elective treatment of asymptomatic type IIIV dAVFs unless patient frailty/medical contraindications exist. […] Due to its less invasive nature, EVT is a more attractive dAVF treatment modality than surgery. […] We recommend that EVT should be tried as the first treatment option in non-hemorrhagic type III/IV dAVFs, given appropriate arterial feeder access. […] Stereotactic radiosurgery (SRS) can be an alternative/adjuvant to elective EVT/surgery of cranial dAVFs, especially of type 1. […] This is independent of whether the symptom at ictus/cause of bleed is acute headache/dAVF venous aneurysm or acute neurological symptoms without headache/bleed from a small parenchymal vein, as we have experienced that both types rebleed early.

• #75 Treatment and outcome of spinal dural arteriovenous fistulas

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3467794/

  Spinal dural arteriovenous fistula (dAVFs) are rare and often misdiagnosed entities. The choice between surgical treatment and embolization remains a matter of debate. […] An attempt at embolization should be made following diagnostic angiography. Otherwise, surgery is our recommended treatment for spinal dural fistulas, as it has a lower failure rate. Because of the progressive natural course with severe deficits, we favor an early definitive treatment. […] The surgical treatment consists of intradural interruption of the draining vein with coagulation or excision of the dural fistula. Alternatively, endovascular treatment with liquid embolic material is possible. […] The usual operative procedure of dural fistulas consisted of a limited hemilaminectomy at the side of the draining vein, excision or clipping of the fistula, no stripping of veins, and an intraoperative Doppler control to demonstrate the elimination of the pathological AV communication.

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

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

  A dural arteriovenous fistula (dAVF) is an abnormal connection between an artery and vein within the protective tissue that surrounds your brain and spinal cord. […] Your healthcare provider will determine the best treatment plan for you. […] Treatment can remove the fistula and improve blood flow in your blood vessels as expected. It can reduce and prevent new symptoms and complications from happening. […] The goal of dural arteriovenous fistula treatment is to remove the abnormal connection (fistula) between your artery and vein. Treatment options could include: […] Surgery: Open surgery can remove the fistula (abnormal connection) of the affected blood vessel. […] Endovascular embolization: This procedure uses a tiny tube, called a catheter, in your artery to reach the affected area and seal off the fistula.

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

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

  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. […] Of the 26 patients (M:F=7:19) who were managed by endovascular embolization of the dAVF, PT disappeared completely in 21 (80.8%), was abated substantially in 3 (11.5%), and remained the same in 2 (7.7%), resulting in a subjective symptom improvement rate of 92.3%. […] No major complications occurred after endovascular treatment. […] General approaches for the management of dAVFs include conservative treatment, endovascular intervention, surgery, and radiosurgery. […] Due to the recent efficacy of endovascular therapy, microsurgical obliteration is often reserved for cases in which endovascular embolization has failed or is not feasible.

• #78 Endovascular treatment strategy, technique, and outcomes for dural arteriovenous fistulas of the marginal sinus region | Journal of NeuroInterventional Surgery

  https://jnis.bmj.com/content/14/2/155

  Endovascular treatment is safe and effective for most FMR-AVF. […] Treatment was endovascular in 21/24 (87.5%), combined (endovascular+surgical) in 2/24 (8.3%), and surgical in 1/24 (4.2%). […] No AVF recurrence was seen for TA/TV, combined endovascular/surgical, or surgical groups, and there was one recurrence (7.1%) in the TV group. […] Symptomatic improvement was seen in all groups: TV (71.4% complete, 28.6% partial), TA (66.7% complete, 33.3% no follow-up), TV+TA (100% partial), endovascular/surgical (100% complete), and surgical (100% partial). […] TV embolization has a high cure rate with few complications.

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

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

  If treated early, motor and sensory function can be improved or stabilized in most cases. Pain and bowel and bladder dysfunction are only reversed in a minority of patients. […] Notably, patients may worsen if initially treated with corticosteroid therapy, which may have been given if an inflammatory pathology such as transverse myelitis was initially suspected.

• #80

  https://scholars.duke.edu/individual/pub1519729

  Cranial dural arteriovenous fistulas (dAVFs) are often treated with endovascular therapy, but occasionally a multimodality approach including surgery and/or radiosurgery is utilized. […] Recurrence of dAVFs after putative cure can occur after endovascular treatment. Risk factors include tentorial location, cortical venous drainage, and deep cerebral drainage. Multimodality therapy can be used to achieve cure after recurrence. A delayed long-term angiographic evaluation (at least 1 year from cure) may be warranted, especially in cases with risk factors for recurrence.

• #81 Arteriovenous Fistula Survival | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-fistula/survival/overview

  Each of these treatments aims to restore normal blood flow, and many patients achieve a cure in that the fistula no longer affects their health or quality of life. However, close monitoring post-treatment is essential to detect any changes or complications early. […] For patients with a high risk of rupture, treatment is often prioritized to prevent life-threatening complications. […] Recovery time after dAVF treatment varies based on the chosen treatment, the fistulas location and complexity, and the individual patients health. […] Recurrence of a dAVF after successful treatment is relatively uncommon but not impossible. […] Regular follow-up appointments, often including imaging, help ensure that any recurrence is detected and managed early. […] Even after successful treatment, ongoing monitoring of a dAVF is crucial. Regular follow-up appointments help healthcare providers assess the stability of the treated dAVF and monitor for any signs of recurrence.

• #82

  https://scholars.duke.edu/individual/pub1519729

  Cranial dural arteriovenous fistulas (dAVFs) are often treated with endovascular therapy, but occasionally a multimodality approach including surgery and/or radiosurgery is utilized. […] Recurrence of dAVFs after putative cure can occur after endovascular treatment. Risk factors include tentorial location, cortical venous drainage, and deep cerebral drainage. Multimodality therapy can be used to achieve cure after recurrence. A delayed long-term angiographic evaluation (at least 1 year from cure) may be warranted, especially in cases with risk factors for recurrence.

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

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

  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.

• #84

  https://scholars.duke.edu/individual/pub1519729

  Cranial dural arteriovenous fistulas (dAVFs) are often treated with endovascular therapy, but occasionally a multimodality approach including surgery and/or radiosurgery is utilized. […] Recurrence of dAVFs after putative cure can occur after endovascular treatment. Risk factors include tentorial location, cortical venous drainage, and deep cerebral drainage. Multimodality therapy can be used to achieve cure after recurrence. A delayed long-term angiographic evaluation (at least 1 year from cure) may be warranted, especially in cases with risk factors for recurrence.

• #85 Arteriovenous Fistula Survival | Expert Surgeon | Aaron Cohen-Gadol, MD

  https://www.aaroncohen-gadol.com/en/patients/arteriovenous-fistula/survival/overview

  Each of these treatments aims to restore normal blood flow, and many patients achieve a cure in that the fistula no longer affects their health or quality of life. However, close monitoring post-treatment is essential to detect any changes or complications early. […] For patients with a high risk of rupture, treatment is often prioritized to prevent life-threatening complications. […] Recovery time after dAVF treatment varies based on the chosen treatment, the fistulas location and complexity, and the individual patients health. […] Recurrence of a dAVF after successful treatment is relatively uncommon but not impossible. […] Regular follow-up appointments, often including imaging, help ensure that any recurrence is detected and managed early. […] Even after successful treatment, ongoing monitoring of a dAVF is crucial. Regular follow-up appointments help healthcare providers assess the stability of the treated dAVF and monitor for any signs of recurrence.

• #86 Treatment of Ethmoidal Dural Arteriovenous Fistulae Using Supraorbital Keyhole Subfrontal Approach

  https://www.mdpi.com/1648-9144/60/7/1128

  Due to a unique cortical venous drainage pattern without sinus drainage, ethmoidal dural arteriovenous fistula (DAVF) are uncommon cerebral vascular lesions that carry a high risk of brain bleeding and neurologic deficit. Surgical intervention has been found to have a lower complication rate and a more satisfactory obliteration rate than endovascular treatment among the various DAVF treatment options. […] For eDAVFs, endovascular embolization and surgery are the two major treatments. Surgery, in particular, offers a significantly lower risk of complications than endovascular techniques, as well as an outstanding record of completely obliterating eDAVFs. […] Surgical disconnection is still the most effective way to treat eDAVFs. […] The treatment of eDAVFs using several modalities has been verified in the literature.

• #87 Treatment of Ethmoidal Dural Arteriovenous Fistulae Using Supraorbital Keyhole Subfrontal Approach

  https://www.mdpi.com/1648-9144/60/7/1128

  Due to a unique cortical venous drainage pattern without sinus drainage, ethmoidal dural arteriovenous fistula (DAVF) are uncommon cerebral vascular lesions that carry a high risk of brain bleeding and neurologic deficit. Surgical intervention has been found to have a lower complication rate and a more satisfactory obliteration rate than endovascular treatment among the various DAVF treatment options. […] For eDAVFs, endovascular embolization and surgery are the two major treatments. Surgery, in particular, offers a significantly lower risk of complications than endovascular techniques, as well as an outstanding record of completely obliterating eDAVFs. […] Surgical disconnection is still the most effective way to treat eDAVFs. […] The treatment of eDAVFs using several modalities has been verified in the literature.

• #88 Treatment of Ethmoidal Dural Arteriovenous Fistulae Using Supraorbital Keyhole Subfrontal Approach

  https://www.mdpi.com/1648-9144/60/7/1128

  Due to a unique cortical venous drainage pattern without sinus drainage, ethmoidal dural arteriovenous fistula (DAVF) are uncommon cerebral vascular lesions that carry a high risk of brain bleeding and neurologic deficit. Surgical intervention has been found to have a lower complication rate and a more satisfactory obliteration rate than endovascular treatment among the various DAVF treatment options. […] For eDAVFs, endovascular embolization and surgery are the two major treatments. Surgery, in particular, offers a significantly lower risk of complications than endovascular techniques, as well as an outstanding record of completely obliterating eDAVFs. […] Surgical disconnection is still the most effective way to treat eDAVFs. […] The treatment of eDAVFs using several modalities has been verified in the literature.

• #89 Treatment of Ethmoidal Dural Arteriovenous Fistulae Using Supraorbital Keyhole Subfrontal Approach

  https://www.mdpi.com/1648-9144/60/7/1128

  In our opinion, for asymptomatic patients with eDAVF, Cognard type IV, the supraorbital keyhole subfrontal approach should be considered as the first-line treatment to eliminate the risk of possible malignant clinical course. […] We recommend early treatment for asymptomatic individuals with eDAVFs who have direct cerebral vein drainage with or without venous ectasia. This is to prevent the possibility of a malignant clinical progression. The supraorbital keyhole subfrontal technique, in combination with neuronavigation, offers a minimally invasive yet efficient approach to treat eDAVFs if patients are meticulously chosen.

• #90

  https://link.springer.com/article/10.1007/s00062-021-01107-0

  Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. […] A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. […] The preferred approach in literature is the transvenous embolization of the CS affected by the fistula. […] In general, the endovascular approach demonstrated a high percentage of radiological (79.5%) and clinical (85%) resolution of the fistula, and a low complication rate (8%), with an almost negligible incidence of permanent deficit. […] A transvenous coiling is the most used endovascular treatment, achieving a high percentage of radiological and clinical resolution with a very low complication rate. In general, transvenous treatments showed less complications than transarterial approaches, and coil occlusion appeared safer than using liquid embolic agents.

• #91

  https://link.springer.com/article/10.1007/s00062-021-01107-0

  Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. […] A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. […] The preferred approach in literature is the transvenous embolization of the CS affected by the fistula. […] In general, the endovascular approach demonstrated a high percentage of radiological (79.5%) and clinical (85%) resolution of the fistula, and a low complication rate (8%), with an almost negligible incidence of permanent deficit. […] A transvenous coiling is the most used endovascular treatment, achieving a high percentage of radiological and clinical resolution with a very low complication rate. In general, transvenous treatments showed less complications than transarterial approaches, and coil occlusion appeared safer than using liquid embolic agents.

• #92

  https://link.springer.com/article/10.1007/s00062-021-01107-0

  Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. […] A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. […] The preferred approach in literature is the transvenous embolization of the CS affected by the fistula. […] In general, the endovascular approach demonstrated a high percentage of radiological (79.5%) and clinical (85%) resolution of the fistula, and a low complication rate (8%), with an almost negligible incidence of permanent deficit. […] A transvenous coiling is the most used endovascular treatment, achieving a high percentage of radiological and clinical resolution with a very low complication rate. In general, transvenous treatments showed less complications than transarterial approaches, and coil occlusion appeared safer than using liquid embolic agents.

• #93

  https://link.springer.com/article/10.1007/s00062-021-01107-0

  Endovascular treatment represents the first-line therapy for cavernous sinus dural arteriovenous fistulas (CS-dAVF); however, different approaches and embolic agents as well as occlusion rates, complications and clinical outcomes are reported among the published series. […] A transvenous coiling is the most common endovascular approach for CS-dAVF, achieving a high percentage of radiological and clinical resolution and low complication rates. […] The preferred approach in literature is the transvenous embolization of the CS affected by the fistula. […] In general, the endovascular approach demonstrated a high percentage of radiological (79.5%) and clinical (85%) resolution of the fistula, and a low complication rate (8%), with an almost negligible incidence of permanent deficit. […] A transvenous coiling is the most used endovascular treatment, achieving a high percentage of radiological and clinical resolution with a very low complication rate. In general, transvenous treatments showed less complications than transarterial approaches, and coil occlusion appeared safer than using liquid embolic agents.

• #94 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. […] The main treatment for DAVF is endovascular embolization. […] The treatment methods for DAVFs include embolization, vascular compression, surgery and stereotactic treatment. […] With the invention of novel materials and devices, endovascular therapy has become the primary method for DAVF treatment. […] The treatment principle is to occlude the dural venous fistula. […] In the present case, a microcatheter was inserted into the fistula of the middle meningeal artery and Onyx-l8 glue was slowly injected, ultimately achieving embolization. […] Following surgery, the symptoms of parkinsonism and dementia were significantly reduced, and the neurological function and scores on the dementia scale showed a substantial increase over the preoperative evaluation.

• #95 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. […] The main treatment for DAVF is endovascular embolization. […] The treatment methods for DAVFs include embolization, vascular compression, surgery and stereotactic treatment. […] With the invention of novel materials and devices, endovascular therapy has become the primary method for DAVF treatment. […] The treatment principle is to occlude the dural venous fistula. […] In the present case, a microcatheter was inserted into the fistula of the middle meningeal artery and Onyx-l8 glue was slowly injected, ultimately achieving embolization. […] Following surgery, the symptoms of parkinsonism and dementia were significantly reduced, and the neurological function and scores on the dementia scale showed a substantial increase over the preoperative evaluation.

• #96 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. […] The main treatment for DAVF is endovascular embolization. […] The treatment methods for DAVFs include embolization, vascular compression, surgery and stereotactic treatment. […] With the invention of novel materials and devices, endovascular therapy has become the primary method for DAVF treatment. […] The treatment principle is to occlude the dural venous fistula. […] In the present case, a microcatheter was inserted into the fistula of the middle meningeal artery and Onyx-l8 glue was slowly injected, ultimately achieving embolization. […] Following surgery, the symptoms of parkinsonism and dementia were significantly reduced, and the neurological function and scores on the dementia scale showed a substantial increase over the preoperative evaluation.

• #97 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

  After one month, the patient was able to take care of himself completely, and after three months, a stereotactic treatment was performed for the residual fistula. […] At the one year follow-up, neurological examination revealed that the patient was recovering normally. […] In conclusion, a DAVF presenting as parkinsonism and dementia is easily misdiagnosed. However, a timely diagnosis is crucial for improved therapeutic outcomes. In cases of rapidly progressive parkinsonism or dementia, accompanied by an abnormal flow void shadow on cranial MRI films, the possibility of a DAVF should be considered. Subsequently, the DAVF should be treated with appropriate and timely selective endovascular treatment, with DSA recommended as soon as possible.

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

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

  It is important to tailor management of DAVF to each patient. Specific goals should be put forward taking into account the natural history of the lesion (which mainly depends on its venous drainage pattern), its specific anatomical features and the patient’s symptoms. Most dural fistulas can be managed by endovascular means but some are more appropriately approached by surgery. Some difficult lesions need the judicious combination of endovascular techniques and surgery. […] Endovascular treatment was recommended to prevent recurrent hemorrhage. He underwent embolization and disconnection of the fistula. […] After an embolization treatment procedure, Dr. Abdalkader and Dr. Nguyen successfully and completely disconnected the fistula.

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

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

  It is important to tailor management of DAVF to each patient. Specific goals should be put forward taking into account the natural history of the lesion (which mainly depends on its venous drainage pattern), its specific anatomical features and the patient’s symptoms. Most dural fistulas can be managed by endovascular means but some are more appropriately approached by surgery. Some difficult lesions need the judicious combination of endovascular techniques and surgery. […] Endovascular treatment was recommended to prevent recurrent hemorrhage. He underwent embolization and disconnection of the fistula. […] After an embolization treatment procedure, Dr. Abdalkader and Dr. Nguyen successfully and completely disconnected the fistula.

• #100 Treatment Within Five Days for Dural Arteriovenous Fistula Hemorrhage

  https://www.brighamhealthonamission.org/2022/10/14/treatment-within-five-days-generally-appropriate-for-dural-arteriovenous-fistula-related-hemorrhage/

  Treatment within five days was associated with a low rate of an early rebleed and appears to be an appropriate timeframe. […] These data suggest treatment within five days is acceptable. In general, though, earlier is better, up to the point where the quality of the procedure may be compromised.

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