Cerebral Dural Arteriovenous Fistulas—an Update on Pathophysiology, Natural History and Treatment

Abstract

Dural arteriovenous fistulas are unique vascular shunts that can be discovered incidentally or after presentation with pulsatile tinnitus, ocular symptoms, focal neurologic deficits, and even hemorrhage. Their natural history is predicated on the shunt’s venous drainage pattern; presentation modality and venous ectasia are also independent factors influencing lesion natural history. Their management is often via endovascular embolization; surgical disconnection of high risk fistulas and radiosurgery for low risk shunts unamenable to embolization are also options. This article will provide a modern update on dural arteriovenous fistula pathophysiology, natural history and treatment approaches.