Dural arteriovenous fistulas

Diagnosis

Your doctor might advise having diagnostic imaging (radiology) tests if you exhibit any of the warning signs or symptoms of a dural arteriovenous fistula. These might apply to dural arteriovenous fistulas and include:

• Initial imaging. Cross-sectional images from magnetic resonance imaging (MRI) and non-contrast head computer tomography (CT) are frequently used in initial evaluation.
• CT head scans. These tests can detect both actual bleeding—which may be brought on by a dAVF but take place elsewhere in the brain’s venous system—and fluid accumulation brought on by increased cortical vein blood pressure.
• MRIs. With the use of these images, it is possible to define the size and location of a dAVF, find any microhemorrhages (extremely minute bleeding areas), and assess the significance of any aberrant blood vessel structures connected to the fistula itself.
• Angiography. The most accurate and conclusive method for diagnosing dAVF is still catheter-based cerebral angiography, commonly known as digital subtraction angiography. It is essential to figure out:
  • The structure of the fistula blood vessel
  • The presence of cardiovascular disease
  • The amount and location of the fistulae
  • The affected vein’s dilatation and extension
  • The narrowing or obstruction of dural sinus
  • The structure of the external carotid arteries, including any branches that lead to the dura

It may also be necessary to do superselective angiography to locate the point at which the feeding dural arteries and the draining vein’s insertion meet.

Treatment

The standard treatment for dural arteriovenous fistula involves surgery to either disconnect or block the abnormal connection between the artery and vein.

• Endovascular procedures. With the aid of X-ray imaging, your doctor may perform an endovascular procedure in which they put a long, thin tube (catheter) into a blood vessel in your leg or groin and thread it through blood vessels to the dural arteriovenous fistula.

In order to block the aberrant blood vessel connection, your doctor inserts the catheter into the blood vessel that supplies the dAVF and releases coils or a glue-like substance.

• Stereotactic radiosurgery. Your doctor will perform stereotactic radiosurgery to block the aberrant blood vessel link using finely focused radiation. The dAVF is destroyed by the fistula’s blood channels closing shut due to the strong radiation dose administered to it. The linear accelerator (LINAC), gamma knife, and proton beam therapy are among the various technological platforms employed in dAVF stereotactic radiosurgery.
• dAVF surgery. You could require dAVF surgery if stereotactic radiosurgery or an endovascular technique are not viable options for you. To disconnect the dAVF, stop the blood supply, and eliminate the fistula, surgery may be performed.