Dural arteriovenous fistulas in the falx cerebri: case series and literature review

Abstract

Background Dural arteriovenous fistulas (DAVFs) in the falx cerebri are seldomly reported. They may be associated with the falcine sinus/venous plexus. The falcine sinus/venous plexus is often considered a normal venous structure that manifests in a pathological state, different from the persistent fetal falcine sinus. Methods We performed a retrospective analysis at a single center, focusing on identifying all DAVFs in the falx cerebri between 2002 and 2022. Our study included the collection and analysis of data on demographics, fistula characteristics, treatment approaches, clinical outcomes, and fistula closure. In addition, we reviewed the literature on DAVFs in this area. Results Ten cases in our center and 13 cases of DAVFs in the falx cerevri reported in the literature were identified. At our center, the average age of the patients was 49.4 ± 8.1 years, and 90% were men. Trans-arterial embolization (TAE) alone resulted in immediate complete occlusion in eight cases. In two cases, conservative treatment was performed. There were no treatment-related complications or fistula recurrences found. According to the literature, seven patients underwent direct surgery, three underwent TAE, and one underwent both direct surgery and radiosurgery to completely close the fistula. There were no reported fistula recurrences or treatment complications. Conclusions Dural arteriovenous fistulas in the falx cerebri are rare, and there is limited literature available on this topic. Most of them are aggressive lesions. Curative treatment can be achieved by TAE or direct surgery. Further confirmation is needed to determine the involvement of the falcine sinus/venous plexus in falx cerebri DAVFs.