Dural arteriovenous fistulae (DAVF)

Question 1

DAVF

Answer 1

Is AVM in the dura
Acquire

Question 2

Supply DAVF

Answer 2

ICA ,ECA, VA
For tentorium DAVF supply ➡️ Arterial feeders are derived from the meningo-hypophyseal trunk, occipital artery, ascending pharyngeal artery, and vertebral artery.

Question 3

Common 📍 for DAVF

Answer 3

🌟 transverse/sigmoid Left
Tentorium ⛺️/ ethrmiodal 👃
Anteriorfossa/ ethmiodal 👃
Middle fossa/ Sylvian
SSs
CCF cavernous= carotid-cavernous fistula (CCF

Question 4

Pahtogensis of DAVF theory

Answer 4

1-Venous thrombosis 💢 awake embryonic dural arteriovenous channels
2-venous hypertension/thrombosis promotes local angiogenesis and the de novo formation of DAVF47

3. the DAVF may arise first and itself result in venous sinus thrombosis

Question 5

Population common

Answer 5

Female
In peds 🧸➡️ complex, bilateral dural sinus malformations.

Question 6

Presentation DAVF

Answer 6

MCC pulstile tinnitus ➡️ high flow fistulas in the transverse sinus/sigmoid location.
Venous HTn ➡️⬆️ ICP , ▶️ poor cerebral venous drainage ▶️ imapre arachnoid granulation ▶️ HC
Carotid - cavernous fistula ➡️ proptosis

Compression of the carotid artery may result in a ⬇️ in bruit intensity.

Question 7

Common cause of morbidity and mortality in DAVF

Answer 7

Venous HTN and ICP

Question 8

Indication for DAVF tx

Answer 8

⏏️ ICP

Question 9

DX of DAVF

Answer 9

CTA
MRA
DSA ⭐️

Question 10

What differencate high from low grade

Answer 10

Cortical venous drainage ▶️ high grade

Question 11

Borden classification

Answer 11

Question 12

Cognard ⭐️⭐️

Answer 12

Applicable

The Cognard classification divides dural arteriovenous fistulas into 5 types according to the following features:

5 Location of fistula 5 Presence of cortical venous drainage 5 Direction of flow 5 Presence of venous ectasia

Retrograde flow to cortical vein are high risk bleeding and IC➖HTn

Question 13

Outcome

Answer 13

90% of beningn DAVF ( no cortical V drain ) reminds benign

aggressive ( cortical V drain ) high risk of 🩸, neurological deficit and mortality

Question 14

Common 📍 for aggressiveDAFV

Answer 14

🏕️ tentorium➡️ middle f/ Sylvia’s ➡️ anterior F / ethmiod

Question 15

Indication for intervention

Answer 15

1. presence of cortical venous drainage
2. neurologic dysfunction
3. hemorrhage
4. orbital venous congestion
5. refractory symptoms (headache, pulsatile tinnitus)or change sx

Question 16

Tx DAVF

Answer 16

Manual carotid self-compression ( thrmbosis rare 22% , clinic
A improvement 33% )
Endovascular ➡️ coil through vein ➡️ 1- close shunt
Surgery ▶️ , fatal hemorrhage 🩸
SRS ▶️ best replant 📍 transverse sigmoid , 1650cgy-1900cgy)

Question 17

Surgical option for DAVF

Answer 17

1. radical fistula excision
2. sinus skeletonization
3. disconnection of cortical venous drainage
4. ligation of the fistulous point and/or outflow vein
5. sinus packing
6. coagulation of arterial feeders to the lesion

Question 18

Most common site favorable for surgery > Endovascular

Answer 18

anterior fossa/ethmoidal

2. tentorial DAVFs

Question 19

risk factors ⬆️ hemorrhage from DAVF

Answer 19

cortical venous drainage, focal neurological deficits, DAVFs located in the posterior fossa, male sex, and increasing age.

Question 20

DAVF antiplatelet or anticoagulant agents should avoid

Answer 20

to prevent interference with spontaneous thrombosis of the DAVF.

Question 21

Transvenous treatment is appropriate

Answer 21

Cognard type IIb fistula

Question 22

Syndrome with DAVF

Answer 22

Ehlers-Danlos syndrome, fibromuscular dysplasia, or neurofibromatosis type 1.

Question 23

SSS DAVF supply

Answer 23

MMA

Question 24

Anterior fossa DAVF presentation

Answer 24

SAh

Question 25

Foramen magnum DAVFs present with

Answer 25

Mylopathy

Question 26

Torcular Herophili DAVFs had

Answer 26

aggressive neurological symptoms.