Cerebral arteriovenous malformations and dural arteriovenous fistulae

Abstract

This chapter on bAVM, DAVF, and CCF describes their development, management, and anticipated outcomes. Arteriovenous malformations (AVM) of the brain are diagnosed annually in 1 per 100 000 population, are acquired early in life and can present with intracerebral haemorrhage (ICH), seizure, headache, or neurological disorders. They rupture for the first time at 1–2% per year. Rate of rerupture is 4–6% per year. Spetzler-Ponce classes A, B, and C allow stratification of most likely treatment options into surgery, radiosurgery, and no intervention, respectively. The less frequent DAVF and CCF are discussed with the management pathways of conservative, embolization, and surgery. Because of the diversity of clinical scenario, decision-making is highly nuanced. CCF constitutes both DAVF involving the cavernous sinus (indirect fistulae) and direct fistula between ICA and sinus. Where multiple treatment pathways are reasonable, treatment is presented to facilitate comparison between modalities as well as providing advantages and disadvantages of each path.