Dural Arteriovenous malformation

Posted by e-Medical PPT
Plexiform arteriovenous fistulae with the nidus of AV shunting totally within the dural leaflet.Fed by pachymeningeal arteries or dural branches of brain or scalp arteries.
Drained by adjacent dural sinuses, or retrograde through leptomeningeal veins. 

DAVM Pathoanatomy and Pathophysiology
Venous hypertension in dural leaflet
Dural sinus outflow restriction/occlusion
Retrograde (leptomeningeal) venous drainage
Secondary sequelae of parenchymal venous hypertension

DAVM Pathoetiology
Sinus occlusion (congenital or acquired)
Trauma (blunt, penetrating, surgical)
Hypercoagulable states (including neoplasia, inflammation, etc…)

DAVM Natural History
Clinical presentation related to lesion location
Aggressive symptoms (hemorrhage, focal neurologic deficits, seizures, etc.) solely related to leptomeningeal venous

Progression, spontaneous resolution highly unpredictable (cavernous sinus DAVMs notable for spontaneous resolution)

DAVM Management Strategies
Expectant and
symptomatic treatment--
surveillance for progression,
aggressive features
Transarterial embolization-- palliative, preparatory, definitive (slow polymerization)
Transvenous embolization-- pathologic segment
Surgery-- disconnection of leptomeningeal venous drainage, coagulation/excision/isolation of pathologic dural leaflet/sinus segment
Stereotactic Radiosurgery-- 18-24 months delayed effect (interval risk)

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