title: Natural history, current concepts, classification, factors impacting endovascular therapy, and pathophysiology of cerebral and spinal dural arteriovenous fistulas.
abstract: Dural arteriovenous fistulas (DAVFs) may occur anywhere there is a dural or meningeal covering around the brain or spinal cord. Clinical manifestations are mostly related to venous hypertension, and may be protean, acute or chronic, ranging from minor to severe, from non-disabling tinnitus to focal neurological deficits, seizures, hydrocephalus, psychiatric disturbances, and developmental delay in pediatric patients. Although low-grade lesions may have a benign course and spontaneous involution may occasionally occur (i.e. cavernous sinus DAVFs), the risk of hemorrhage is considerable in high grade lesions. Angiographic features of DAVFs have been clarified since the 1970s when venous drainage pattern was clearly identified as the most significant risk predictor and as a major determinant of success or failure of treatment. The mainstay of therapy is interruption of arteriovenous shunting, which has traditionally been accomplished surgically. Currently, endovascular therapy is generally considered the first line of treatment, allowing elimination of the lesion in most patients, with surgery and stereotactic radiosurgery reserved for complex situations. This review discusses major aspects of DAVFs, including grading systems, clinical presentation, diagnostic evaluation, various issues impacting endovascular therapy, and pathophysiology.
authors.affiliation: Radiological Associates of Sacramento Medical Group Inc, 1500 Expo Parkway, Sacramento, 95815, USA. Electronic address: lhaceinbey@yahoo.com.
authors.forename: Lotfi
authors.initials: L
authors.lastname: Hacein-Bey
authors.affiliation: UCLA Medical Center, Radiology Department, Los Angeles, USA.
authors.forename: Angelos Aristeidis
authors.initials: AA
authors.lastname: Konstas
authors.affiliation: Neurological Surgery, P.C., 600 Northern Boulevard, Suite 118, Great Neck, 11021, USA; Columbia University, Department of Biomedical Engineering, New York, USA.
authors.forename: John
authors.initials: J
authors.lastname: Pile-Spellman
mesh_terms: D002426:Cavernous Sinus / Q000473:pathology*; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D054022:Cerebrum / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D013116:Spinal Cord / Q000098:blood supply / Q000473:pathology / Q000601:surgery*
keywords: Angiography; Arteriovenous fistula; Dural; Endovascular; Magnetic resonance imaging