A Mayo Clinic neurologist converses with a woman about her diagnosis.
If you have signs or symptoms of a dural arteriovenous fistula (dAVF), your doctor may recommend that you undergo diagnostic tests, including:
Initial evaluation typically includes cross-sectional imagery from noncontrast head computerized tomography (CT) and magnetic resonance imaging (MRI).
CT head scans can show fluid buildup caused by heightened cortical vein blood pressure as well as actual bleeding, which may be caused by a dAVF but occur elsewhere in the brain's venous system.
MRIs can establish the shape and extent of a dAVF, detect any micro-hemorrhages (very small bleed locations), and determine the impact of any abnormal blood vessel structures related to the fistula itself.
Brain MRI scan
An MRI is administered to a person.
Catheter-based cerebral angiography (also known as digital subtraction angiography) is still the most reliable and definitive tool on dAVF diagnosis. It's essential for defining:
- How many fistulae exist and where
- Anatomy of the external carotid arteries and any branches between them and the dura
- Fistula blood vessels' structure
- Whether cardiovascular disease is also present
- How much narrowing or blockage has occurred in the dural sinus
- Whether any affected veins are dilated and to what extent
Superselective angiography may also be required to identify the area of convergence of the feeding dural arteries and the origin of the draining vein.
Neurosurgery for dural arteriovenous fistulas
Mayo Clinic neurosurgeons review surgical options for a dural arteriovenous fistula.
Endovascular procedures. In an endovascular procedure, your doctor may insert a long, thin tube (catheter) into a blood vessel in your leg or groin and thread it through blood vessels to the dural arteriovenous fistula using X-ray imaging.
Your doctor inserts the catheter into the blood vessel that leads to the dAVF and releases coils or a glue-like substance to block the abnormal connection in the blood vessels.
- Stereotactic radiosurgery. In stereotactic radiosurgery, your doctor uses precisely focused radiation to block the abnormal connection in the blood vessels.
- Surgery. Your surgeon may perform surgery to disconnect the dAVF.
Preparing for your appointment
What you can do
- Keep a detailed symptoms calendar. Each time a symptom occurs, write down the time, what you experienced and how long it lasted.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Take a family member or friend along. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Bring along any recent brain scans in a CD to your appointment.
Also, if you've experienced seizures, your doctor may want to ask questions of someone who has witnessed them, as it's common not to be aware of everything that happens when you experience one.
Write down questions to ask your doctor.
Preparing a list of questions will help you make the most of your time with your doctor. List your questions from most important to least important in case time runs out. Most of these would be covered during your visit. Some examples of good questions to ask your doctor include:
- Where is the fistula located?
Management and observation
- Will I need follow-up tests?
- If so, how often will I follow up with you?
Surgery (to disconnect a fistula)
- How long would you estimate I'd be in surgery?
- How long does surgery recovery usually take?
- How long should I plan to be in the hospital?
- How many dAVFs have you seen and how many have you treated?
- Does your institution have a cerebrovascular specialty practice?
In addition to the questions you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is also likely to ask you a number of questions:
- When did you first begin experiencing symptoms (for example, hearing or vison problems, seizures, speech issues, palsies, or other symptoms)?
- Do your symptoms come and go (intermittent) or are they persistent?
- Do your symptoms seem to be triggered by certain events or conditions?
What you can do in the meantime
Certain conditions and activities can trigger seizures, so it may be helpful to:
- Avoid excessive alcohol consumption
- Avoid nicotine usage
- Get enough sleep
- Reduce stress
Dural arteriovenous fistulas care at Mayo Clinic
March 16, 2019
- Arteriovenous fistula. The Merck Manual Professional Edition. http://www.merckmanuals.com/professional/cardiovascular_disorders/peripheral_venous_disorders/arteriovenous_fistula.html. Accessed Aug. 17, 2017.
- Ghobrial GM, et al. Dural arteriovenous fistulas: A review of the literature and a presentation of a single institution's experience. World Neurosurgery. 2013;80:94.
- Riggin EA. Allscripts EPSi. Mayo Clinic, Rochester, Minn. April 18, 2017.
- Eisen A. Disorders affecting the spinal cord. http://www.uptodate.com/search. Accessed Aug. 18, 2017.
- What is an arteriovenous malformation (AVM)? American Stroke Association. http://www.strokeassociation.org/STROKEORG/AboutStroke/TypesofStroke/HemorrhagicBleeds/What-Is-an-Arteriovenous-Malformation-AVM_UCM_310099_Article.jsp. Accessed July 25, 2017.
- Rammos S, et al. Endovascular management of intracranial dural arteriovenous fistulae. Neurosurgery Clinics of North America. 2014;25:539.
- Lanzino G, et al. Endovascular treatment of intracranial dural arteriovenous fistulas. World Neurosurgery. 2014;82:318.
- Vellimana AK, et al. Dural arteriovenous fistulas associated with benign meningeal tumors. Acta Neurochirurgica. 2014;156:535.
- Holekamp DF, et al. Dural arteriovenous fistula–induced thalamic dementia: Report of 4 cases. Journal of Neurosurgery. 2016;124:1752.
- Lanzino G (expert opinion). Mayo Clinic, Rochester, Minn. August 9, 2017.
- Cerebral arteriovenous malformation. U.S. National Library of Medicine Medline Plus.https://medlineplus.gov/ency/article/000779.htm. Accessed July 28, 2017.
- Cannizzaro D, et al. Changing clinical and therapeutic trends in tentorial dural arteriovenous fistulas: A systematic review. American Journal of Neuroradiology. 2015;36:1905.
- Eisen A. Disorders affecting the spinal cord. https://www.uptodate.com/contents/search. Accessed July 25, 2017.
- Reynolds MR, et al. Intracranial dural arteriovenous fistulae. Stroke. 2017;48:1424.
- Reynolds MR, et al. Supplemental material: Intracranial dural arteriovenous fistulae. Stroke. 2017;48(suppl):1.
- Klaas JP (expert opinion). Mayo Clinic, Rochester, Minn. August 9, 2017.
Dural arteriovenous fistulas