History of Management of Dural Arteriovenous Fistulas in Children

Understanding of Disease

• 1873 — First described: In 1873, Rizzoli reported the first cranial DAVF as an AVM that involved the dura mater (1).
• 1931 — First angiographic description: Sachs made the first angiographic description of a cranial DAVF in 1931 (2).
• 1962 — First treatment via arterial ligation: Verbiest was the first to attempt to treat cranial DAVF by arterial ligation, in 1962 (3).
• Late 20th and early 21st centuries — Evolving understanding of pathogenesis: Initially, the pathogenesis of DAVFs was mostly attributed to acquired vascular malformations on the arterial side. More recently, the attention has gradually shifted to the venous end (4). It is purported that venous outlet obstruction, venous hypertension, and shunting into dormant venous channels in the dura may connect external carotid circulation to the venous circulation (5).

Technological Development

• Late 20th century — Interventional neuroradiology: In the late 20th century, angiographic quality became sufficient to visualize, categorize, and facilitate the treatment of these lesions (8).  The majority of DAVFs are now treated endovascularly (6). Open cranial surgery still has a role, in certain locations (eg, the anterior fossa) and in patients in whom endovascular treatment was not successful (7).

Surgical Technique

• 1960s and 1970s — Microneurosurgery: With the introduction and modification of the surgical microscope in the 1960s and 1970s, microsurgery became the mainstay technique to treat cerebrovascular disorders (9,10).