Description

Dural arteriovenous fistulas (dAVFs) are irregular connections between arteries and veins. Occur in the dura covering the spinal cord or the brain, known as the dura mater. The irregularity of the aisles between the arteries and the veins are arteriovenous fistulae, which can lead to bleeding in the brain or other serious symptoms.

Dural Avfs are rare. They tend to occur between the ages of 50 and 60. They are usually not genetic, so that children are not more likely to develop a dAVF if your parent has one.

Despite the fact that some dAVFs mother of known causes, most often, the cause is not known. It is believed that dAVFs involving large veins of the brain are formed when one of the brain's venous sinuses are narrow or blocked. Venous sinuses are channels that route the circulation of blood from the brain toward the heart.

Treatment for dAVF usually involves an endovascular procedure or stereotactic radiosurgery to block the flow of blood to the dAVF . Or, surgery may be needed to disconnect or remove the dAVF .

Symptoms

Some people with dural arteriovenous fistulas (dAVFs) may not have symptoms. When symptoms do occur, they may be characterized as benign or aggressive. An aggressive dAVF has more severe symptoms.

AggressivedAVFsymptoms may be the result of bleeding in the brain, known as intracerebral hemorrhage. Bleeding in the brain often cause a sudden headache. It can also cause other symptoms, based on the location and the size of the hemorrhage.

Aggressive symptoms can also result from nonhemorrhagic neurological deficit (NHNDs), which may include seizures or changes in mental abilities. These symptoms usually develop more gradually, in the course of days to weeks. The symptoms are usually related to the area of the brain affected.

Aggressive symptoms may include:

  • Sudden headache.
  • Difficulty walking and falls.
  • Seizures.
  • Speech or language problems.
  • The Facial pain.
  • Dementia.
  • Slowness of movements, rigidity and tremor, known as parkinson's disease.
  • Problems with coordination.
  • Burning or prickling sensations.
  • The weakness.
  • The lack of interest, known as apathy.
  • Failure to thrive.
  • Symptoms related to the increase of the pressure, such as headaches, nausea, and vomiting.

OtherdAVFsymptoms may include hearing problems. People with hearing symptoms can hear a rhythmic sound in the ear that occurs with the beat of the heart, known as pulsatile tinnitus. Symptoms can also include problems with vision, such as:

  • Changes in vision.
  • Eye bulge.
  • The swelling in the eye lining.
  • The paralysis of a muscle in or around the eye.

Rarely, dementia can occur due to an increase of the pressure in the blood vessels in the brain.

When to see a doctor

Make an appointment with your health care professional if you have any of the symptoms that are not normal or that worry you.

Seek medical help right away if you have seizures or symptoms that suggest a brain hemorrhage, such as:

  • Sudden, severe headache.
  • Nausea.
  • Vomiting.
  • Weakness or numbness on one side of the body.
  • Difficulty speaking or understanding the language.
  • The loss of vision.
  • Double vision.
  • Problems with balance.

Causes

The majority of dural arteriovenous fistulas (dAVFs) are not clear on the source. But some are the result of a traumatic brain injury, a previous infection of the brain surgery, blood clots in deep veins or tumors.

Most of the experts believe that dAVFs involving large veins of the brain are produced from the narrowing or blockage of one of the brain's venous sinuses. The venous sinuses are channels in the brain that the path that circulates the blood from the brain toward the heart.

Risk factors

Risk factors for dural arteriovenous fistulas (dAVFs) include being inclined to the formation of blood clots in the veins, which are known as thrombosis of the vein. The changes in the way that blood clots can increase the risk of a blockage or narrowing of the venous sinuses.

More often, dAVFs affect people between the ages of 50 and 60. But it can occur in people at young ages, even in children.

The research has found that the non-cancerous tumors are found in the membranes that surround the brain and spinal cord may be associated with dAVFs .

Diagnosis

If you have symptoms of a dural arteriovenous fistula (dAVF), you may need imaging tests.

  • CTscans. These tests can show accumulation of fluid caused by the increase of the blood pressure in the brain. You can also show bleeding that can be caused by a dAVF .
  • The magnetic resonance. Magnetic resonance imaging may show the form of a dAVF . An mri can also detect very small bleeds. The test can determine the impact of any spot of the blood vessels of the structures.
  • The angiography. Catheter-based cerebral angiography, also known as digital subtraction angiography, is the most reliable tool to diagnose dAVF . It is essential for the definition of:
  • How many of the fistulas that there are and where.
  • Anatomy of the external carotid arteries and any branches between them and the dura mater. The carotid arteries supply blood to the brain and head.
  • Fistula of the blood vessels of the structure.
  • If cardiovascular disease is also present.
  • How much narrowing or blockage has occurred in the sinus dural.
  • If any of the affected veins are dilated and to what extent.
  • How many of the fistulas that there are and where.
  • Anatomy of the external carotid arteries and any branches between them and the dura mater. The carotid arteries supply blood to the brain and head.
  • Fistula of the blood vessels of the structure.
  • If cardiovascular disease is also present.
  • How much narrowing or blockage has occurred in the sinus dural.
  • If any of the affected veins are dilated and to what extent.

Treatment

The treatment of a dural arteriovenous fistula (dAVF) is a procedure to lock or disconnect the fistula.

Dural arteriovenous fistula surgery

The procedures that can treat dAVF include:

  • The endovascular procedures. In an endovascular procedure, a long, thin tube called a catheter is inserted into a blood vessel in the leg or groin. It is threaded through blood vessels to the dural arteriovenous fistula, the use of x-ray images. The coils or a glue-like substance is released to lock the connection of the blood vessels.
  • Stereotactic radiosurgery. In stereotactic radiosurgery, precisely focused radiation of the blocks of the irregularity of the connection in the blood vessels. This causes the blood vessels in the fistula to close, the destruction of the dAVF . The different types of technology can be used in stereotactic radiosurgery. These include the linear accelerator, Gamma knife and proton therapy.
  • dAVFsurgery. If an endovascular procedure or stereotactic radiosurgery are not options for you, you may need to dAVF surgery. Surgery may be performed to disconnect the dAVF or cut off the blood supply and remove the fistula.

Preparing for your appointment

What you can do

  • Maintain a detailed of the symptoms of the calendar. Each time a symptom occurs, make a note of the date and 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 you are taking.
  • Have a family member or friend. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who comes with you may remember something that you missed or forgot.
  • Bring along any recent explorations of the brain in a CD to your appointment. Also, if you have experienced seizures, your healthcare provider may want to ask questions to someone who has been a witness of them. It is common to not be aware of everything that happens during a seizure.

Write down questions to ask your doctor.

Prepare a list of questions will help you make the most of your time during your appointment. A list of questions from most important to least important in case time runs out. Some examples of questions are:

General Questions

  • Where is the fistula is located?

The management and observation

  • I need follow-up tests?
  • If so, how often can I continue with you?

The surgery to disconnect a fistula

  • What is the estimated time I would be in surgery?
  • How much recovery time of the surgery usually take?
  • How long should I be in the hospital?

Surgical history

  • How many dAVFs have you seen and how many have tried?
  • Does your institution have stroke specialty practice?

In addition to the questions that we have prepared, do not hesitate to ask the others during your appointment anytime you don't understand something.

What to expect from your doctor

Your healthcare provider is likely to ask a series of questions:

  • When did you first begin experiencing symptoms? For example, has experienced hearing or vision problems, seizures, speech problems, paralysis or other symptoms?
  • Do your symptoms come and go 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 that may trigger seizures, so that it can be helpful if you:

  • Do not drink excessive amounts of alcohol.
  • Do not use nicotine.
  • Get enough sleep.
  • Reduce stress.
The symptoms and treatment of Dural arteriovenous fistulas