Brain Dural Arteriovenous Fistulas (DAVFs): Symptoms and Treatments

The brain is covered and protected by a tough outer covering called the dura mater. A brain dural arteriovenous fistula (DAVF) is a type of vascular abnormality that occurs in the dura mater when an artery and a vein connect directly. A DAVF can result in bleeding that can be life threatening. New Jersey Brain and Spine offers cutting-edge imaging techniques to diagnose DAVFs and provides a wide range of treatment options.

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What is a Brain Dural Arteriovenous Fistula?

A brain dural AV fistula is an abnormal connection between an artery that carries high-pressure blood and a vein that carries low pressure blood. Normally, blood flows through capillaries that slow blood flow to allow for the efficient exchange of oxygen and nutrients. In a DAVF, the capillaries are bypassed, allowing blood to flow directly from the artery into the vein, increasing pressure in the vein. As pressure increases, the vein can rupture, resulting in bleeding.  

Bleeding often causes sudden onset of symptoms that may include:

• Sudden, severe headache
• Difficulty speaking or understanding speech
• Nausea and vomiting
• Seizure
• Loss of consciousness

Acute symptoms from bleeding may include:

• Sudden, severe headache (“thunderclap” headache)
• Difficulty speaking or understanding speech
• Nausea and vomiting
• Seizures or convulsions
• Loss of consciousness or altered mental state

Progressive symptoms from increased venous pressure:

• Persistent headaches that worsen over time
• Pulsatile tinnitus (rhythmic whooshing sound in ear)
• Visual problems including eye redness, swelling, or vision loss
• Progressive muscle weakness or coordination problems
• Facial numbness, pain, or paralysis
• Speech difficulties or cognitive changes

What Causes a DAVF? 

The majority of brain dural arteriovenous fistulas have no identifiable cause. Some hereditary vascular diseases have been associated with a higher likelihood of developing a DAVF and there is evidence that they can result from a blockage or clot in the venous sinuses, infection, or head trauma. While a DAVF can affect anyone at any age, it most commonly occurs in adults between the ages of 40 and 60 years old.

How are DAVFs Diagnosed?

Brain dural arteriovenous fistulas are diagnosed through imaging, primarily cerebral angiography; however magnetic resonance imaging (MRI) or computed tomography (CT) scan may also be used.

• Cerebral angiography involves injecting a dye into the bloodstream to highlight blood vessels so doctors can see using X-ray if they are narrowed or blocked.
• MRI can show the location of abnormal connections between arteries and veins as well as the impact on surrounding tissues.  
• A CT scan combines X-ray with computer technology to produce detailed mages of bones, muscles, fat, organs and blood vessels.

Treatment Options for a DAVFs

Most people with dural AV fistulas can be cured with an endovascular embolization, a minimally invasive procedure in which the surgeon inserts a catheter into the affected blood vessel to place an object that blocks blood flow to the vessel. This prevents the vein from rupturing and bleeding.

An alternative procedure called microsurgical resection may be used when embolization is not possible or the fistula is in a harder to reach location. An incision is made in the skull, and the surgeon uses an operating microscope with small tools to reach and disconnect the affected area, cutting off blood supply while minimizing damage and scarring to surrounding tissue. 

Stereotactic radiosurgery, including gamma knife therapy, targets tissue with radiation beams to damage the abnormal blood vessels, causing them to seal off. 

Regardless of the procedure, most patients recover within 3 months and people experience long-term symptom relief without complications like bleeding. However, because DAVFs can cause severe complications, it is important to address them early.

Patient Success Story: Robert’s Recovery

Robert Chen, a 52-year-old accountant from Wayne, New Jersey, had been experiencing a persistent “whooshing” sound in his left ear for several months. Initially dismissed as stress-related tinnitus, the pulsatile sound became increasingly bothersome and was accompanied by occasional headaches.

“The sound was driving me crazy,” Robert recalls. “It was like hearing my heartbeat in my ear constantly. I couldn’t concentrate at work or sleep properly.”

After consulting his primary care physician, Robert was referred to New Jersey Brain and Spine. Dr. Karimi’s team performed a comprehensive evaluation including MRI and cerebral angiography, which revealed a dural arteriovenous fistula near his left ear.

“Dr. Karimi explained that the whooshing sound was actually blood flowing abnormally through the fistula,” Robert says. “He recommended endovascular embolization to close off the abnormal connection.”

The minimally invasive procedure took approximately 90 minutes. Using a tiny catheter threaded through blood vessels, Dr. Karimi placed specialized coils to block the abnormal blood flow. Robert went home the next day with immediate relief from his symptoms.

“The whooshing stopped completely after the procedure,” Robert reports six months later. “I can’t believe something so debilitating could be fixed so effectively. The NJBS team gave me my peace and quiet back.”

[Patient name and details have been changed for privacy]

New Jersey Brain and Spine neurosurgery experts offer a full range of procedures to diagnose and treat DAVFs successfully. If you’re experiencing symptoms or have been diagnosed with a dural arteriovenous fistula, contact us to develop a comprehensive treatment plan that will reduce your risk of complications.