Dural Arteriovenous Fistula

KEY FACTS

IMAGING

• Location: Dural sinus wall

○ Posterior fossa >> supratentorial

○ Can involve any dural sinus (transverse/straight sinus

most common)

• NECT

○ Usually normal; ICH if outlet vein thrombosed or flowrelated aneurysm, venous pouch ruptures

• Bone CT

○ Dilated transosseous calvarial vascular channels, ±

enlarged foramen spinosum

• MR

○ Isointense thrombosed sinus ± flow voids on T1/T2WI

○ Thrombosed dural sinus blooms on T2*

○ May show parenchymal hemorrhage in dAVF with

cortical venous drainage

○ FLAIR: Isointense thrombosed sinus ± adjacent edema if

venous congestion or ischemia present

• MR/CTA: Network of tiny (crack-like) vessels in wall of

thrombosed dural venous sinus

TOP DIFFERENTIAL DIAGNOSES

• Hypoplastic transverse-sigmoid sinus; sigmoid sinus-jugular

foramen pseudolesion; thrombosed dural sinus; dural sinus

stenosis

PATHOLOGY

• Adult dAVFs are usually acquired, not congenital; can occur

in response to trauma, venous sinus thrombosis;

pathological activation of neoangiogenesis

CLINICAL ISSUES

• 10-15% of all cerebrovascular malformations with AV

shunting

• Adult >> child

• Prognosis depends on location, venous drainage pattern

• Treatment options: Endovascular, surgery, stereotaxic XRT

(Left) Clinical photograph in a

patient with a "red eye"

secondary to a dural

arteriovenous fistula (dAVF) of

the cavernous sinus. (Top)

Note prominent scleral vessels

﬈, focal hemorrhages ﬊.

(Bottom) After endovascular

treatment of the cavernous

dAVF, the eye appears normal.

(Right) Graphic depicts dAVF

with thrombosed transverse

sinus ﬈. Multiple

transosseous branches ﬉

from the external carotid

artery supply innumerable tiny

arteriovenous fistulae ﬊ in

the dural wall.

(Left) Lateral view of an

external carotid DSA depicts

typical angiographic findings

of dAVF. The ipsilateral

transverse sinus is occluded

﬈, and there are multiple

prominent branches from the

posterior auricular artery ﬉

supplying a dAVF ﬊ in the TS

wall. The occipital artery ﬇ is

markedly enlarged. (Right)

Selective injection of the OA in

the same patient nicely

demonstrates the mass-like

dAVF ﬊ in the occluded TS.

Note innumerable enlarged

transosseous branches ﬉ that

pass intracranially to supply

the dAVF.

Trauma, and Stroke

Brain: Pathology-Based Diagnoses: Malformations,

119