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Treatment of Intracranial Dural Arteriovenous Fistulas: Current Strategies Based on Location and Hemodynamics, and Alternative Techniques of Transcatheter Embolization¹

¹ From the Department of Radiology, Oita Medical University, 1–1 Hasama, Oita, 879–55, Japan (H.K., Y.H., M.O., S.T., Y.S., S.M., H.M.); and the Department of Neurosurgery, Nagatomi Neurosurgical Hospital, Oita, Japan (H.N.). Recipient of a Cum Laude award for an education exhibit at the 2003 RSNA scientific assembly. Received March 1, 2004; revision requested April 20 and received June 3; accepted June 3. All authors have no financial relationships to disclose. Address correspondence to H.K. (e-mail: hkiyosue@med.oita-u.ac.jp).

Intracranial dural arteriovenous fistulas (AVFs) can occur anywhere within the dura mater. Patients may be clinically asymptomatic or may experience symptoms ranging from mild symptoms to fatal hemorrhage, depending on the location (eg, cavernous sinus, transverse-sigmoid sinus, tentorium, superior sagittal sinus, anterior fossa) and venous drainage pattern of the AVF. In the past, dural AVFs have been treated with a variety of approaches, including surgical resection, venous clipping, transcatheter embolization, radiation therapy, or a combination of these treatments. Recent developments in catheter intervention now allow most patients to be cured with transcatheter embolization, although stereotactic radiation therapy is demonstrating good results in an increasing number of cases and surgery is still the preferred option in some cases. Familiarity with drainage patterns, the risk of aggressive symptoms, recent technical advances, and current treatment strategies is essential for the treatment of intracranial dural AVFs.

© RSNA, 2004

Index Terms: Angiography, 17.124 • Arteries, therapeutic embolization, 17.1264 • Arteriovenous malformations, dural, 17.75 • Cavernous sinus, 176.757 • Fistula, arteriovenous, 17.757 • Fistula, therapeutic embolization, 17.1264 • Sinuses, dural, 176.757 • Sinuses, superior sagittal, 176.757 Veins, therapeutic embolization, 17.1264

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