Dural Arteriovenous Fistulas in Children Homepage

Authors

Zsombor Gal, BA

Keng Siang Lee, MBChB, MRes

Heather Spader, MD

Updated from a prior version by

Ramon Navarro, MD

Gary K. Steinberg, MD, PhD

Section Editors

Edward Smith, MD

Gianpiero Tamburrini, MD

Alfred Pokmeng See, MD

Editor in Chief

Rick Abbott, MD

Introduction

Dural AV fistulas — also referred to as dural AV malformations — are vascular abnormalities in which arteries arising from branches of the carotid or vertebral arteries drain directly into the veins or venous sinuses, bypassing capillaries. Symptoms vary mostly according to age at presentation. They are exceedingly rare in children, and their diagnosis and management can be difficult.

Key Points

• Nidus malformation within dura: Cranial DAVFs are abnormal AV connections between the arterial vessels and the venous sinus or leptomeningeal vein. The pathological connection is located within the dura.
• High-risk lesions: Cranial DAVFs with cortical venous drainage are considered high-risk lesions and should be treated promptly, even if asymptomatic.
• Neurointerventional treatment with support from surgery: Most of these lesions are primarily treated by neurointerventional means. Surgery plays a vital role when endovascular means cannot achieve complete obliteration of the malformation or in locations where it is technically difficult or risky to navigate endovascular devices.
• Aim is to disconnect the arterial circulation from the venous circulation: The aim of treatment is to disconnect the venous draining system from the fistulous point.
• High recurrence rate: There is a high recurrence rate, often from incomplete closure of the true fistulous point. Long-term follow-up is warranted.