Fact-sheet: Arteriovenous fistula - intracranial
Updated on 09/30/2019 at 6:22 PM
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Definition
Arteriovenous shunts developing within the thickness of the dura mater.
Congenital or acquired origin
Role of venous thrombotic phenomena (fistulas occurring after deep venous thrombosis)
Clinical features
Sensorimotor deficit
Tinnitus perceived on auscultation+++ (lateral sinus dural AVF)
Ophthalmologic signs (cavernous sinus dural AVF)
Seizures if cortical venous drainage is present
Headaches
Cognitive impairment
CT
Venous ectasia
Early opacification of the dural sinuses following contrast administration
Complications such as infarction and/or hemorrhage
MRI
Venous ectasia
Abnormal flow signal within the dural sinuses/veins on 3D TOF sequences with abnormal arterial supply.
Early opacification of the dural sinuses following contrast administration
Complications such as infarction and/or hemorrhage
Management
Treatment indications:
AVF with cortical venous drainage
– Risk of hemorrhage or non-hemorrhagic neurological
deficit
– This risk is higher in cases of hemorrhage or non-hemorrhagic deficit at diagnosis
– Indication for complete treatment
AVF without cortical venous drainage
– Often benign course
Therapeutic options:
Endovascular treatment (EVT):
– First-line treatment.
Surgery:
– EVT failures
– Anterior fossa AVFs (ethmoidal AVFs).
Stereotactic radiotherapy:
– Delayed efficacy
Classification
Angiographic classification of Borden et al., 1995:
– Type I: sinus drainage without cortical venous drainage
– Type II: sinus drainage with cortical venous reflux
– Type III: direct cortical venous drainage
Angiographic classification of Cognard et al., 1995:
- Type I: antegrade sinus drainage
- Type IIa: sinus drainage with retrograde
sinus reflux
- Type IIb: sinus drainage with reflux into a
cortical vein
- Type IIa+b: sinus drainage with sinus and cortical venous reflux
- Type III: direct drainage into cortical veins
- Type IV: direct drainage into cortical veins with venous ectasia
- Type V: perimedullary spinal venous drainage
