Selection of treatment modalities or observation of dural arteriovenous fistulas.

Cranial dural arteriovenous fistulas (DAVFs) represent an important class of cranial vascular lesions. The clinical significance of these lesions is highly dependent on the pattern of venous drainage, with cortical venous reflux being an important marker of an aggressive, high-risk fistula. For asymptomatic benign fistulas, conservative management, consisting of observation with follow-up, is a reasonable option. For symptomatic benign fistulas or aggressive fistulas, treatment is recommended. A variety of treatment modalities are available for DAVF management, including endovascular techniques, open surgery, and radiosurgery. A multimodality approach is often warranted and can offer improved chances of achieving a cure.