title: Dural arteriovenous fistulas: a review of the literature and a presentation of a single institution's experience.
abstract: OBJECTIVE
  Dural arteriovenous fistulas (DAVFs) are arteriovenous shunts from a dural arterial supply to a dural venous channel, typically supplied by pachymeningeal arteries and located near a major venous sinus. A retrospective review was conducted to present the results of endovascular obliteration of DAVFs, with particular emphasis of newer liquid embolic agents, including Onyx-18 (MV3, Irvine, California, USA).
  
  
  METHODS
  A review of the literature was performed, and a presentation of the number of treatments, complications, and outcomes is included here. The number of arterial embolizations and need for transvenous embolization, open surgery, and radiosurgery was assessed as well as normalization of retrograde cortical venous drainage.
  
  
  RESULTS
  Thirty-nine patients (22 men and 17 women) underwent endovascular treatment of DAVFs at our institution from 2001 to 2009. Ages ranged from 39 to 71 years (mean, 48 years). Seventy-nine percent of patients had retrograde cortical venous drainage. The average number of embolizations in all patients was 2.1. Twelve patients underwent 40 embolization treatments with Onyx, with an obliteration rate of 75% and cortical venous drainage obliteration rate of 85%. Seventy-one percent (28/39) of patients had complete treatment of the fistula: 21 by purely endovascular treatment and 7 with endovascular therapy followed by craniotomy, as well as seven patients who underwent stereotactic radiosurgery after embolization.
  
  
  CONCLUSIONS
  Endovascular management of DAVFs is a safe and effective method of treating these complex lesions.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: George M
authors.initials: GM
authors.lastname: Ghobrial
authors.forename: Edward
authors.initials: E
authors.lastname: Marchan
authors.forename: Anil K
authors.initials: AK
authors.lastname: Nair
authors.forename: Aaron S
authors.initials: AS
authors.lastname: Dumont
authors.forename: Stavropoula I
authors.initials: SI
authors.lastname: Tjoumakaris
authors.forename: L Fernando
authors.initials: LF
authors.lastname: Gonzalez
authors.forename: Robert H
authors.initials: RH
authors.lastname: Rosenwasser
authors.forename: Pascal
authors.initials: P
authors.lastname: Jabbour
mesh_terms: D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D002533:Cerebral Angiography; D018450:Disease Progression; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011145:Polyvinyls / Q000627:therapeutic use; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D011379:Prognosis; D016634:Radiosurgery; D015607:Stents; D013635:Tantalum / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum