Management of Dural Arteriovenous Fistulas

Dural arteriovenous fistula (DAVF) is an acquired lesion. The dural arteries connect with the dural veins within the dura mater in the histopathological study. Sinus type involves the cavernous sinus, transverse-sigmoid sinus, superior sagittal sinus, and anterior condylar confluence (or condylar canal). Non-sinus type involves the anterior cranial base, falcotentorial region, craniocervical junction, convexity, and spinal dura mater.Radical treatment is to obliterate the draining veins in any treatment modalities including endovascular treatment or surgical treatment. Radiosurgery is the last choice. Transvenous embolization plays a main role in the DAVF of the cavernous sinus and anterior condylar confluence. Transarterial embolization with Onyx has dramatically improved the obliteration rate of the transverse-sigmoid, superior sagittal sinuses, and other non-sinus lesions. Transarterial NBCA injection is still the gold standard in the endovascular treatment of the spinal dural and epidural AVFs. Understanding of the functional microvascular anatomy is mandatory, especially in the transarterial liquid injection (Onyx and NBCA). Surgical treatment in the DAVF of the anterior cranial base, craniocervical junction, tentorial region, and spine is a safe and radical treatment. Postoperative follow-up is necessary from the viewpoint of chronological and spacial multi-occurrence of this disease.