The most accurate method for detecting a dural AV fistula is catheter angiography of the cerebral vessels. This examination can assess the vessels involved in the fistula and the blood flow in the fistula; details that must be available prior to any treatment decision.
Depending on the location and extent of the fistula, there are several treatment options. In most cases, catheter-based methods are first used to attempt to close (embolize) the fistula. This procedure is performed under general anesthesia. For this purpose, a thin catheter is inserted into the fistula via the groin or the wrist. An embolization agent (liquid glue) is injected into the fistula through the catheter to close it. An attempt can also be made to eliminate the dural fistula from the venous side with a venous occlusion (e.g. with coils). Both access routes, via artery or vein, are possible and often, a combination of both is chosen.
The goal of treatment is always complete closure of the fistula. Depending on the size and location of the fistula, several treatments (embolizations) may be necessary. If this is not successful, the fistula remnant may be closed microsurgically.
Endovascular treatment of dural arterio-venous fistulas
(A) The illustration shows an arterio-venous fistula in the region of the transverse sinus. A feeding artery with high pressure, which divides into several small vessels (artery, red) opens directly into the venous system (blue, transverse sinus).
(B) A small balloon catheter (green arrow) is navigated into the feeding artery, just in front of the fistula. The goal of the treatment is to eliminate the network of small vessels in order to close the vein. For this purpose, it is protected with a second balloon (black arrows).
(C) The network of small vessels was closed with a special glue (black) without closing the vein.
