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.
dAVFs are often spontaneous, but they may occur as a result of:
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:
To find out if you have a dAVF, your doctor will ask you about your symptoms.
dAVF symptoms may include:
To diagnose a dAVF, your doctor may order tests such as:
Treatments for dAVF — including surgery — vary based on the type of dAVF (low- or high-risk).
Treatment options may include:
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 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.
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.