Dural arteriovenous fistula
4204404
179726670
2007-12-23T04:03:59Z
Arcadian
104523
ref
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| Caption = This dural arteriovenous fistula of the [[superior sagittal sinus]] drains into subarachnoid veins and is classified as Borden type IIIb.
| DiseasesDB = 32954
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A '''dural arteriovenous fistula''', also called a '''dural arteriovenous malformation''', is an abnormal direct connection ([[fistula]]) between a meningeal [[artery]] and a meningeal [[vein]] or [[dural venous sinus]].
==Classification==
The [[Jonathan Borden|Borden]] Classification of Dural arteriovenous malformations or fistulas, groups into three types based upon their venous drainage:<ref name="pmid7815143">{{cite journal |author=Borden JA, Wu JK, Shucart WA |title=A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment |journal=J. Neurosurg. |volume=82 |issue=2 |pages=166–79 |year=1995 |pmid=7815143 |doi=}}</ref>
# Type I: dural arterial supply drains anterograde into venous sinus.
# Type II: dural arterial supply drains into venous sinus. High pressure in sinus results in both anterograde drainage and retrograde drainage via subarachnoid veins.
# Type III: dural arterial supply drains retrograde into subarachnoid veins.
===Type I===
Type I dural arteriovenous fistulas are suppied by meningeal arteries and drain into a meningeal vein or dural venous sinus. The flow within the draining vein or venous sinus is anterograde.
#[http://www.jonathanborden-md.com/DAVF/Type-Ia.jpg Type Ia] -- simple dural arteriovenous fistulas have a single meningeal arterial supply
#[http://www.jonathanborden-md.com/DAVF/Type-Ib.jpg Type Ib] -- more complex arteriovenous fistulas are supplied my multiple meningeal arteries
The distinction between Types Ia and Ib is somewhat specious as there is a rich system of meningeal arterial collaterals. Type I dural fistulas are often asymptomatic, do not have a high risk of bleeding and do not necessarily need to be treated.
===Type II===
The high pressure within a [http://www.jonathanborden-md.com/DAVF/Type-II.jpg Type II] dural AV fistula causes blood to flow in a retrograde fashion into subarachnoid veins which normally drain into the sinus. Typically this is because the sinus has outflow obstruction. Such draining veins form venous varices or aneuryms which can bleed. Type II fistulas need to be treated to prevent hemorrhage. The treatment may involve embolization of the draining sinus as well as clipping or embolization of the draining veins.
===Type III===
Type III dural AV fistulas drain directly into subarachnoid veins.<ref name="title">{{cite web |url=http://www.jonathanborden-md.com/DAVF/Type-III |title=jonathanborden-md.com |accessdate=2007-12-22 |format= |work=}}</ref> These veins can form aneurysms and bleed. Type III dural fistulas need to be treated to prevent hemorrhage. Treatment can be as simple as clipping the draining vein at the site of the dural sinus. If treatment involves embolization, it will only typically be effective if the glue traverses the actual fistula and enters, at least slightly, the draining vein.
==Treatment==
One approach used for treatment is [[embolization]].<ref name="pmid18077948">{{cite journal |author=Carlson AP, Taylor CL, Yonas H |title=Treatment of dural arteriovenous fistula using ethylene vinyl alcohol (onyx) arterial embolization as the primary modality: short-term results |journal=J. Neurosurg. |volume=107 |issue=6 |pages=1120–5 |year=2007 |pmid=18077948 |doi=}}</ref>
==See also==
* [[Arteriovenous fistula]]
==References==
{{reflist}}
==External links==
*[http://www.jonathanborden-md.com/DAVF/ slideshow]
[[Category:Diseases]]