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Dural Arteriovenous Fistulae: Static or Dynamic? Aggressive Natural History and Treatment Options

Explore the etiology, embolization, surgical disconnection, and radiation options for dural arteriovenous fistulae with venous drainage worsening. Understand the correlation with vascular growth factors and implications for therapy. Neuroradiological insights from case reports and experimental investigations.

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Dural Arteriovenous Fistulae: Static or Dynamic? Aggressive Natural History and Treatment Options

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  1. Dural Arteriovenous Fistulae Static or Dynamic? • Cognard et al • seven patients with documented worsening of venous drainage • aggressive natural history • Neuroradiology 39:59, 1997

  2. Dural AVFsExperimental Investigation Common carotid/external jugular anstamosis Dural AVFs only with sinus thrombosis J Neurosurg 80:884, 1994 J Neurosurg 83:539, 1995

  3. Dural AVFsExperimental Investigation Dural AVFs with sinus thrombosis and venous hypertension Correlation with angiogenesis index Implied role in pathogenesis of vascular growth factors (VEGF) J Neurosurg 87:267, 1997

  4. Dural Arteriovenous Fistulae Etiology • Arteriovenous malformation affecting the transverse dural venous sinus - an aquired lesion • Houser et al. Mayo Clin Proc 54:651, 1979

  5. Dural Arteriovenous Fistulae Embolization • Transarterial and/or Transvenous • Symptom palliation • Angiographic cure

  6. Transvenous Embolization Venous access Indication for therapy 24 patients 4% perm morbidity 96% clinical cure Roy & Raymond Neurosurgery 40:1133, 1997

  7. Dural Arteriovenous Fistulae Surgical Options • resection • packing • Endo et al J Neurosurg 88:449, 1998 • disconnection • Collice et al J Neurosurg 84:810, 1996

  8. Surgical Disconnection:Work in Progress • Norris J et al • 1988- present, 141 patients with dural AVFs • Surgical disconnection • 35 Borden Grade III, 12 Borden Grade II • All grade III patients disconnected had angiographic cure • All Grade II lesions converted to Grade I with stable clinical follow-up

  9. Dural Arteriovenous Fistulae:Radiation? • case reports • biological target • target size eg thickness • indication for therapy • time to cure vs natural history

  10. Cavernous Malformations

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