Alkhaibary Ali, Alnefaie Nada, Alharbi Ahoud, Alammar Hajar, Arishy Alshaymaa M, Alshaya Wael, Khairy Sami
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ar Rimayah, Riyadh 14611, Riyadh, 11426, Saudi Arabia.
King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Acta Neurol Belg. 2023 Apr;123(2):359-366. doi: 10.1007/s13760-022-02133-6. Epub 2022 Nov 14.
Dural arteriovenous fistulas (DAVF) are abnormal acquired intracranial vascular malformations consisting of pathological connections located within the dura between the pial arteries and the veno vasora, comprising the walls of the dural sinuses, bridging veins, or transosseous emissary veins. Dural arteriovenous fistulas are distinguished from arteriovenous malformations by their arterial supply from the vessels that perfuse the dura mater and lack of a parenchymal nidus. They are most commonly situated at the transverse and cavernous sinuses. The mechanism of development behind dural arteriovenous fistula can be explained by the molecular and anatomical factors. Multiple classification systems have been proposed throughout history including; Djindjian and Merland, Cognard, and Borden classification systems. The aggressiveness of the clinical course in intracranial dural arteriovenous fistula can be predicted through the angiographic patterns of venous drainage, more specifically, the presence of cortical venous drainage, the presence of venous ectasia, and the aggressiveness of clinical presentation. Intracranial dural arteriovenous fistulas might be discovered incidentally. However, if symptomatic, the clinical presentation ranges from mild neurological deficits to severe, lethal intracranial hemorrhage. Angiography is the imaging of choice to investigate, diagnose, and plan treatment for intracranial dural arteriovenous fistula. The management algorithm of intracranial dural arteriovenous fistula can be broadly divided into conservative, surgical, endovascular, and/or radiosurgical options. With the advent of endovascular therapies, surgery has fallen out of favor for managing intracranial dural arteriovenous fistulas. In the present article, the pathophysiology, classifications, natural history, clinical manifestations, radiological features, management, and complications are comprehensively reviewed.
硬脑膜动静脉瘘（DAVF）是一种后天获得性颅内血管畸形，由软脑膜动脉与静脉血管（构成硬脑膜窦壁、桥静脉或经骨导静脉）之间硬脑膜内的病理性连接组成。硬脑膜动静脉瘘与动静脉畸形的区别在于其动脉供血来自灌注硬脑膜的血管且缺乏实质瘤巢。它们最常位于横窦和海绵窦。硬脑膜动静脉瘘的发病机制可通过分子和解剖学因素来解释。历史上已提出多种分类系统，包括金迪扬和梅兰分类系统、科尼亚尔分类系统和博登分类系统。颅内硬脑膜动静脉瘘临床病程的侵袭性可通过静脉引流的血管造影模式来预测，更具体地说，是通过皮质静脉引流的存在、静脉扩张的存在以及临床表现的侵袭性来预测。颅内硬脑膜动静脉瘘可能是偶然发现的。然而，如果出现症状，临床表现范围从轻度神经功能缺损到严重的致命性颅内出血。血管造影是研究、诊断和规划颅内硬脑膜动静脉瘘治疗的首选影像学检查。颅内硬脑膜动静脉瘘的治疗算法可大致分为保守治疗、手术治疗、血管内治疗和/或放射外科治疗。随着血管内治疗的出现，手术在治疗颅内硬脑膜动静脉瘘方面已不再受青睐。在本文中，将对其病理生理学、分类、自然史、临床表现、放射学特征、治疗及并发症进行全面综述。
