Neuroendovascular Management of Dural Arteriovenous Malformations
Section snippets
Clinical features of dural arteriovenous fistulas and anatomic considerations for embolization
The clinical features associated with dAVFs generally depend on the location of the lesion, the extent of the AV shunting, and associated abnormalities of venous drainage.1, 5 Symptoms may be indistinguishable from those associated with pial brain AVMs and may include headache, diplopia, blurred vision, or neurologic dysfunction. Focal neurologic deficits and seizures may develop in relation to disturbances in regional cortical venous drainage resulting from the redirection of venous flow from
Neuroimaging of intracranial dural arteriovenous fistulas
Recent advances in CT and MRI have significantly contributed to the initial diagnostic evaluation of patients with suspected dAVFs. Although routine conventional head CT or brain MRI is not infrequently diagnostically equivocal, dilated or thrombosed venous structures suggesting the presence of a lesion may be identified, particularly in patients with dAVFs associated with cortical venous drainage. In patients presenting with intracranial hemorrhage, obvious findings are evident in CT and MRI
Therapeutic approaches to dural arteriovenous fistulas
An understanding of the natural history of the disease, the treatment options, and the risks and benefits of endovascular therapies is important in the development of a treatment plan. Although spontaneous resolution of clinical signs related to dAVFs has been reported, most notably in patients with cavernous sinus lesions, most symptomatic dAVFs require some form of treatment. This is most urgent in those fistulas accompanied by cortical venous drainage and venous ectasias. The goals of
Summary
Recent advances in endovascular therapies and studies of the anatomic and functional properties of dAVF led to a rapid evolution in their diagnosis and management. The decision of which approach and embolic agent to use for treatment of a dAVF must be tailored to individual cases, recognizing that the most effective approach for permanent dAVF treatment, particularly in high-flow shunts, may require a combination of approaches and embolic agents.
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