1 What are Dural Arteriovenous Fistulas?

Dural arteriovenous fistulas are abnormal connections between an artery and the dura mater of the brain or spinal cord and a draining vein.

Arteriovenous fistulas may occur in any part of the body. These fistulas mostly occur in adults and account for 10 to 15 percent of all cerebral vascular malformations.

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2 Symptoms

The signs and symptoms of dural arteriovenous fistulas depend on the location of supplying and draining vessels.

Signs and symptoms may include:

  • Tinnitus (ringing sound in the ears)
  • Orbital symptoms, such as swelling or redness of the eyes
  • Cranial nerve palsies
  • Symptoms of venous hypertension, such as raised intracranial pressure and focal neurological deficits
  • Stroke-like symptoms, such as a headache and seizures

Some cases of dural arteriovenous fistula are asymptomatic.

3 Causes

The exact cause of dural arteriovenous fistulas is not clearly understood as fistulas occur spontaneously.

4 Making a Diagnosis

Imaging tests, such as CT scan and MRI of the brain are required for the diagnosis of dural arteriovenous fistula.

An angiogram, a test in which a catheter is inserted into an artery in the groin and a dye is injected into the arteries of interest, is also required.

5 Treatment

Treatments for dural arteriovenous fistulas include:

Endovascular procedures in which a catheter is inserted into a blood vessel of the leg or groin and is moved through blood vessels to the dural arteriovenous fistula using X-ray imaging. Coils or glue-like substance is then released to block the abnormal connection in the blood vessels.

Steriostatic radiosurgery in which radiation is used to block the abnormal connection in the vessels.

Surgery to disconnect the dural arteriovenous fistula.

6 Risks and Complications

Complications associated with dural arteriovenous fistulas include:

  • Hemorrhage, which can be subdural, intracranial or subarachnoid
  • Intracranial hypertension
  • Vonous congestion and edema
  • Spinal myelomalacia

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