Dural arteriovenous fistulas (dAVFs) represent innumerable tiny abnormal connections between arteries and veins, usually on the surface of the brain.
They most commonly occur on the side of the head, but can occur behind the eyes, over the top of the head, or in other more unusual places.
If the drainage into the veins is reversed, it increased the venous pressure in the brain and increased the risk of bleeding.
Without the reversal of drainage, there is not thought to be an increased risk of bleeding, but some patients still choose to have their dural arteriovenous fistulae treated, because of the debilitating noise it causes (pulse synchronus tinitus)
Whilst these can sometimes be diagnosed clinically, or on CT or MRI scan, a digital subtraction angiogram is the only way to exclude this disease.
Treatment
Endovascular embolisation is the preferred method of treatment of almost all dural fistulas. Occasionally it may take more than one treatment to completely fix the fistula. Very rarely is open surgery now required, (the old way of treating these lesions), although in special cases a combined endovascular and surgical approach is needed.
