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Dural Arteriovenous Fistula (dAVF)

What Is a Dural Arteriovenous Fistula?

Dural arteriovenous fistulas (dAVFs) are rare, abnormal connections between arteries and veins in the lining of the brain (the dura).

Doctors classify dAVFs as either low-risk or high-risk.

Low-risk dAVFs cause drainage into veins of the brain but keep drainage within the dura in the venous sinuses.

High-risk dAVFs pressurize veins of the brain itself (cortical veins) and cause a risk of stroke-like symptoms or hemorrhage.

dAVF causes

dAVFs are often spontaneous, but they may occur as a result of:

  • Head trauma
  • Infection
  • Surgery
  • Blood clot in a venous sinus

UPMC neurosurgeons may use both surgical and non-surgical approaches to treat dAVFs. Surgical treatment depends on the type of dAVF.

Treatment for dAVFs may include:

  • Embolization
  • Gamma Knife® radiosurgery
  • Neurosurgical disconnection

Dural Arteriovenous Fistula (dAVF) Symptoms and Diagnosis

To find out if you have a dAVF, your doctor will ask you about your symptoms.

Symptoms of dAVF

dAVF symptoms may include:

  • Ringing or humming in the ears (pulsatile tinnitus)
  • Headaches
  • Visual troubles — bulging or swollen eyes, red eye, vision changes, double vision
  • Stroke-like symptoms or seizures

Tests to diagnose dAVFs

To diagnose a dAVF, your doctor may order tests such as:

  • Brain angiogram (the “gold standard” for a precise diagnosis)
  • CT scan
  • MRI scan

Dural Arteriovenous Fistula (dAVF) Treatment Options

Treatments for dAVF — including surgery — vary based on the type of dAVF (low- or high-risk).

Treatment options may include:

Embolization treatment for dAVF

Embolization is a minimally invasive treatment.

It involves passing a small catheter via a blood vessel in the groin through connecting blood vessels of the dAVF.  Your neurosurgeon will then deposit glue, coils or, most commonly, Onyx (an occlusive substance) to close off the fistula.

Gamma Knife® radiosurgery for dAVF

Gamma Knife radiosurgery uses highly focused radiation in a single session to target the dAVF.

The effect isn't immediate, but it's a safe treatment option especially for people with low-risk dAVFs that can’t have complete embolization.

Neurosurgical disconnection dAVF treatment

In cases of high-risk dAVFs where embolization isn’t an option, surgical disconnection can effectively cure the fistula.

Your neurosurgeon will perform a craniotomy over the dAVF and remove the affected lining of the brain (dura) and draining vein.