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What is Dural Arteriovenous Fistula?
Written by Medicover Team and Medically Reviewed by Dr Shrikant Deshmukh , Neurologist
A dural arteriovenous fistula (DAVF) is an abnormal connection between arteries and veins located in the dura mater, the outer protective layer covering the brain and spinal cord. Instead of blood flowing through the normal capillary network, it bypasses directly from arteries into veins, which can increase pressure and disrupt normal brain or spinal cord function.
Is a Dural Arteriovenous Fistula a Common Condition?
Dural arteriovenous fistulas are considered rare, with only a small number of cases diagnosed each year. In the U.S., they are estimated to occur in fewer than 1 out of every 500,000 people annually.
Is a Dural Arteriovenous Fistula a Serious Condition?
The seriousness of a dural arteriovenous fistula can vary. Some cases are harmless and may not cause problems, while others can lead to severe complications. If the abnormal vessels rupture or put pressure on the brain, it can result in bleeding, brain damage, or even a stroke.
What are the Symptoms of Dural Arteriovenous Fistula?
A dural arteriovenous fistula (DAVF) can cause different symptoms depending on where it forms and how much pressure it puts on nearby veins. Some people may not notice anything at first, while others may have clear warning signs.
Early Symptoms Include
- Frequent or throbbing headaches
- A pulsing sound in one ear (pulsatile tinnitus)
- Blurry or double vision
- Red or swollen eyes
- Sudden numbness or weakness, often on one side
- Signs of a stroke, like confusion or a drooping face
Are There Different Types of Dural Arteriovenous Fistulas?
Yes, dural arteriovenous fistulas (DAVFs) are grouped into types based on how and where the abnormal blood flow travels. These types help doctors understand the risk and decide how to treat them.
Borden Classification (Simple 3-Type System)
- Type I: Blood flows normally into a nearby vein or sinus. This type is usually low-risk and might not need immediate treatment.
- Type II: Some blood flows backward into small brain veins. This can increase pressure and may lead to bleeding or swelling.
- Type III: All blood drains directly into brain veins without using the larger sinus. This type is the most dangerous and needs quick treatment.
Cognard Classification (More Detailed System)
This system looks at the same thing, where the blood goes, but breaks it down into more steps.
- Type I: Normal drainage. Usually harmless.
- Type IIa: Some blood goes the wrong way in large veins.
- Type IIb: Blood flows back into brain veins.
- Type IIa+b: A mix of the two above.
- Type III IV: Blood drains only into brain veins and may cause bulging or weak spots. These types have a higher risk of bleeding.
- Type V: The abnormal blood drains toward the spine. This may affect the spinal cord.
What Causes a Dural Arteriovenous Fistula and Whos at Risk?
A dural arteriovenous fistula (DAVF) happens when a blood vessel connects abnormally inside the brain's outer covering, called the dura mater. These connections can form suddenly or over time. While doctors don't always know why they occur, several possible causes and risk factors have been identified.
Possible Causes
- Head Injury: Trauma to the skull or brain can damage blood vessels and lead to abnormal connections.
- Blood Clots in Brain Veins: Clots can block blood flow, forcing nearby vessels to reroute and form a fistula.
- Brain or Spine Surgery: Some DAVFs develop after procedures involving the brain or spinal cord.
- Infections: Serious infections in or around the brain can change how blood vessels behave.
- Increased Pressure in Brain Veins: If blood can't drain properly, pressure builds up, and this may trigger abnormal vessel growth.
Risk Factors
- Age (Usually Over 50): DAVFs are more common in older adults.
- High Blood Pressure: Long-term high blood pressure can damage blood vessels and increase the risk.
- Blood Clotting Problems: Conditions that affect how your blood clots may also affect how veins drain.
- Smoking and Alcohol Use: These habits can harm blood vessels over time.
- Hormonal Changes (Rare): In a few cases, pregnancy or hormonal shifts may play a role.
Get a second opinion from trusted experts and makeconfident, informed decisions.
Get Second OpinionHow Is Dural Arteriovenous Fistula Diagnosed?
Diagnosing a dural arteriovenous fistula (DAVF) isn't always simple. The symptoms can look like other brain or nerve problems, so clear and accurate testing is important. Doctors use a few imaging tests to spot where the abnormal connection is and how serious it may be.
Tests You Might Need
- MRI (Magnetic Resonance Imaging): This scan gives a detailed view of the brain. It can show if there's unusual blood flow or pressure.
- MRA (Magnetic Resonance Angiography): This looks closely at the brain's blood vessels and helps spot abnormal connections.
- CT Scan or CT Angiography (CTA): These are useful in emergencies to check for bleeding or swollen veins in the brain.
- Digital Subtraction Angiography (DSA): This is the most accurate test for DAVFs. It shows real-time images of blood flow and helps doctors plan treatment.
How Is a Dural Arteriovenous Fistula Treated?
The treatment for a dural arteriovenous fistula (DAVF) depends on its location, size, and how much it affects blood flow in the brain. Some DAVFs don't need immediate care, while others require quick treatment to prevent serious problems like bleeding or stroke.
Endovascular Embolization
This is a minimally invasive procedure. A thin tube is guided through the blood vessels to the fistula, and a special material is used to block the abnormal connection.
- Hospital stay: Usually 1 to 2 days
- Recovery: Most people return to daily routines within 1to 2 weeks
Microsurgery
In some cases, surgery is needed to close off the fistula. The surgeon carefully disconnects the abnormal vessel through a small opening in the skull.
- Hospital stay: 3 to 5 days
- Recovery: Light activity in 2 weeks, full recovery in about a month
Stereotactic Radiosurgery (Gamma Knife or CyberKnife)
This method uses focused radiation to close the fistula over time. Its painless and done without cuts.
- Hospital stay: Usually not required
- Recovery: You can go home the same day, but it may take months for the fistula to fully close
Medications and Supportive Care
While they don't cure the condition, medicines can help manage symptoms like headaches or seizures. Blood pressure control is also important to reduce stress on brain vessels.
When Should You See a Doctor?
If you're dealing with strange or ongoing symptoms, its always a good idea to check with a doctor. A dural arteriovenous fistula (DAVF) can be serious if left untreated, but early care can make a big difference.
Watch for These Symptoms
See a doctor if you notice any of the following
- Headaches that don't go away
- A pulsing sound in one ear
- Blurry or double vision
- Red or swollen eyes without an infection
- Dizziness or trouble keeping your balance
These signs may be linked to abnormal blood flow in the brain and should not be ignored.
Get Emergency Help If You Notice
- Sudden weakness or numbness on one side
- Slurred speech or difficulty understanding others
- Loss of vision
- Seizures or fainting
- Signs of a stroke (like confusion or facial drooping)
If you or someone near you shows any of these symptoms, call emergency services right away.
Who's More at Risk?
You may have a higher chance of developing a DAVF if you
- Are over the age of 50
- Have high blood pressure
- Have had a blood clot in the brain
- Recently had brain surgery or trauma
If you fall into any of these groups and have ongoing symptoms, it's best to get checked early.
What Can Happen If a DAVF Is Not Treated?
Some DAVFs may not cause problems right away. But if the abnormal blood flow gets worse, it can lead to serious health issues.
Possible Complications
- Stroke: Increased pressure in the brain's veins may lead to bleeding.
- Seizures: Abnormal blood flow can irritate brain tissue.
- Brain swelling: Caused by poor drainage or blocked veins.
- Vision or hearing loss: If the fistula is near the eye or ear.
- Memory or thinking problems: In rare cases, pressure in the brain can affect mental functions.
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Our Experience in Treating Dural Arteriovenous Fistula
At Medicover Hospitals, we understand how overwhelming it can be to face a condition like a dural arteriovenous fistula. That's why we focus on providing not just advanced treatment but also compassion and support throughout your journey.
Our team of neurologists, neurosurgeons, and interventional radiologists has helped many individuals recover safely and return to their normal lives. From the first consultation to recovery, we are here to guide you with clear answers, timely care, and Specific treatment plans.
