Advance Access: Angio-Architectural Features of High-Grade Intracranial Dural Arteriovenous Fistulas: Correlation With Aggressive Clinical Presentation and Hemorrhagic Risk

Intracranial dural arteriovenous fistulas (dAVF) consist of a direct arteriovenous shunt, located in the dural layer, near a dural sinus. The blood supply comes from branches or dural meningeal branches of the cerebral arteries, while their drainage is carried out through the venous system of the brain (dural venous sinuses, brain leptomeningeal veins, emissary veins, or their combination).1 dAVFs are considered acquired vascular lesions and constitute about 10% of all intracranial arteriovenous shunt.2,3

Rizzoli, in 1881, was the first to describe an arteriovenous malformation, “involving the dura,” and Sachs in 1931 reported the first angiographic description of a dAVF. These consist of many small connections between branches of intracranial arteries and veins or dural venous sinuses.1 Classically, the clinical manifestations are classified into 3 major categories: (I) benign clinical presentation, (II) aggressive clinical presentation, and (III) hemorrhagic event4 (Table 1).

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