Follow-up for Dural Arteriovenous Fistulas in Children

Frequency of Office Visits

• Scheduling follow-up: The first follow-up visit with the neurosurgery team should occur 1 to 2 weeks after surgery to assess the wound status and for suture/staple removal, if needed. Future follow-ups are at 1 to 3 months, 6 months, and yearly.

Frequency of Imaging

• Annual MRI: Arrangements should be made for serial follow-up appointments, because these dynamic lesions may recur. An initial imaging study can be scheduled at 6 months (MRI/MRA/MR venography). If 2 consecutive studies rule out recurrence a yearly MRI/MRA/MR venography can be performed for about 5 years in patients with clinically stable, treated DAVFs to avoid excessive radiation exposure. After that, the imaging interval may be extended.
• Angiography if evidence of recurrence: In cases of clinical or radiological suspicion of recurrence, obtain additional angiography.

Other Investigations Required

• Hematology consult: For hypercoagulable states, a hematology consult is recommended.
• Neuropsychological testing: Neuropsychological testing could be helpful, especially if there is a preoperative study for comparison. Venous congestion can lead to more diffuse symptoms with an insidious onset.