Dural Arteriovenous Fistulae
Dural Arteriovenous Fistula:
At a Glance
What it is: A dural arteriovenous fistula (dAVF) is an abnormal connection between an artery and a vein in the dura mater, the tough outer covering of the brain.
How it affects people: Some dAVFs cause no symptoms. Others lead to headaches, vision or hearing problems, or in severe cases, stroke or intracranial hemorrhage.
Key concern: A dAVF can increase pressure in the venous sinuses, leading to brain haemorrhage or damage if left untreated.
Diagnosis: Usually identified with specialist brain imaging such as MRI, CT angiography, or cerebral angiography.
Treatment options: Observation, endovascular treatments, or cranial dural arteriovenous fistula surgery depending on the location and whether it is high risk.
Outlook: With expert care from a neurosurgeon, most patients achieve safe and effective outcomes.
What is a Dural Arteriovenous Fistula (dAVF)?
A dural arteriovenous fistula (dAVF) is an abnormal link between arteries and veins in the dura mater, the covering of the brain. This creates unusual blood flow patterns and can put pressure on the venous sinuses and draining veins of the brain.
While some dAVFs remain small and harmless, others may cause headaches, tinnitus, or neurological symptoms. In more severe cases, a dAVF may lead to intracranial hemorrhage or stroke if blood cannot flow normally.
Types of dAVFs
Doctors classify dAVFs based on how blood drains through the veins:
Low-risk dAVF: Blood drains normally into larger dural sinuses. These may cause few or no symptoms.
High-risk dAVF: Blood is diverted into smaller veins, which can increase the chance of bleeding or neurological deficits
This classification helps specialists choose the safest treatment plan for each patient.
Symptoms of Dural Arteriovenous Fistulae
Common symptoms
Headaches
Pulsating noise in the ear (pulsatile tinnitus)
Vision problems
Eye redness or swelling
Dizziness or imbalance
Venous Hypertension & Pulsatile Tinnitus
One of the hallmark symptoms of a dAVF is pulsatile tinnitus, a rhythmic whooshing sound in the ear caused by turbulent blood flow. This happens because the fistula alters how blood drains through the brain’s venous system, a problem called venous hypertension.
Emergency / red flag symptoms
Sudden severe headache
Seizures
Weakness or numbness on one side of the body
Loss of speech or vision
Loss of consciousness
Some patients also develop neurological deficits such as speech difficulties, weakness, or sensory changes.
Call 999 immediately if you develop sudden neurological symptoms.
Causes and Who Is at Risk
The exact cause of dAVFs is not always clear. They may develop spontaneously or after events that affect blood vessels in the dura mater.
Causes include:
Blood clotting in venous sinuses
Head trauma or surgery
Infections (rare)
Age-related changes in blood vessels
Health and Family Factors You Can’t Change
Age (more common over 40)
Family history of vascular problems
Being male (slightly higher risk)
Doctors note that dAVFs include both acquired and sometimes inherited vessel weaknesses. Having a risk factor does not mean you will definitely develop a dural arteriovenous fistula.
Reducing Your Risk
You cannot always prevent a dural AVF, but you can reduce the risk of complications by:
Controlling high blood pressure
Avoiding smoking
Attending regular follow-up scans if diagnosed
Seeking specialist advice quickly if new symptoms develop
Getting a Diagnosis
A diagnosis of dural arteriovenous fistula requires specialist imaging tests.
MRI scan: Provides detailed images of blood flow in the brain.
CT angiography: Uses contrast dye to show arteries and veins.
Cerebral angiography: The most accurate test, showing exactly how blood moves through the fistula.
These tests allow neurosurgeons to confirm the diagnosis and create a tailored treatment plan.
Treatment Options for dAVF
Dural arteriovenous fistula treatment options depend on the type, location, and severity of the condition.
Observation
Small, low-risk dAVFs may be monitored with regular scans.
Endovascular Treatments
Techniques where a catheter is guided through the blood vessels to close the fistula.
Surgical Intervention
In some cases, open surgery (cranial dural arteriovenous fistula surgery) may be required to disconnect the abnormal connection
Stereotactic Radiosurgery
A focused radiation treatment that may be offered if endovascular or open surgery is not suitable.
Treatment decisions for dAVFs are made through a multidisciplinary approach involving neurosurgeons, neuroradiologists, and stroke specialists who work together to determine the safest and most effective plan, whether that involves endovascular therapy, surgery, or observation.
Mr Kailaya-Vasan, a leading neurovascular surgery specialist in the UK, collaborates closely with this expert team to provide personalised, evidence-based care. He is widely recognised as one of the best neurosurgeons in London for dural arteriovenous fistula management.
Living with with a dAVF
Many patients with dAVFs live well with regular monitoring or treatment. For those needing surgery or an endovascular procedure, outcomes are generally very good.
Long-term follow-up is essential, as some fistulas can return or new ones can form. Regular scans, healthy lifestyle choices, and managing high blood pressure all help reduce future risks.
Recurrence & Follow-Up
Unlike some other vascular conditions, dAVFs can occasionally recur after treatment. For this reason, long-term follow-up with MRI scan or angiography is recommended. Regular monitoring allows doctors to detect any changes early and provide timely treatment if needed. Imaging also helps confirm whether treatment has resulted in closure of the dural venous sinus or if further care is required.
Book a consultation with Mr Ahilan Kailaya-Vasan
Receive a clear diagnosis and a tailored treatment plan from a leading consultant neurosurgeon. Appointments are available at top London hospitals, with remote options for international patients.
Seeking a second opinion?
If you have already received a diagnosis elsewhere, Mr Kailaya-Vasan can provide an independent review of your scans and medical notes, and explain the safest and most effective next steps.
FAQs about Dural Arteriovenous Fistulae
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It is an abnormal connection between arteries and veins in the dura mater, the covering of the brain.
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Common symptoms include headaches, pulsatile tinnitus, and vision changes. Red flag symptoms include seizures, weakness, or sudden loss of consciousness.
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Through imaging tests such as MRI scan, CT angiography, or cerebral angiography.
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No. Low-risk dAVFs may only need monitoring. High-risk fistulas usually need endovascular treatment for dural arteriovenous fistula, or surgery. In rare cases stereotactic radiosurgery is utilised.
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What is recovery like after dAVF treatment?
Most patients recover well. Recovery time depends on whether the treatment was endovascular embolization, surgical, or radiosurgical, but many return to normal activities within weeks. -
Yes. Many cases are managed using endovascular treatments which can safely treat dAVFs without open surgery.
If you have any further questions, please get in touch.