Understanding the Role of Endovascular Treatment in Dural AV Fistula Management

By Dr. Carnevale

When patients receive a diagnosis of dural arteriovenous fistula (DAVF), they often feel overwhelmed by the complexity of their condition and uncertain about what lies ahead. As a New Jersey-based neurosurgeon who specializes in both traditional surgical approaches and cutting-edge endovascular techniques, I want to help you understand this condition and provide you with confidence that modern medicine offers highly effective treatment options that can dramatically improve your quality of life.

Having treated hundreds of patients with dural AV fistulas over the past decade, I’ve witnessed firsthand how transformative proper treatment can be. In this article, I’ll share more about remarkable advances in endovascular treatment and how these minimally invasive techniques are revolutionizing the way we approach care. 

What Are Dural AV Fistulas?

To understand why endovascular treatment is so effective, it’s important to first grasp what we’re treating. A brain dural arteriovenous fistula is a type of vascular abnormality that occurs in the dura mater when an artery and a vein connect directly. This abnormal connection can cause a range of symptoms depending on its location and the direction of blood flow. Patients may experience:

• Sudden, severe headaches
• Difficulty speaking or understanding speech
• Nausea and vomiting
• Seizures
• Loss of consciousness
• 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

The variability in symptoms often means that patients have seen multiple specialists before receiving an accurate diagnosis, which can be both frustrating and frightening.

What I want every patient to know is that once properly diagnosed, dural AV fistulas are highly treatable conditions. The key is working with a team that has extensive experience in both diagnosis and the full spectrum of treatment options available.

Endovascular Treatment for Dural AV Fistula

Years ago, treating dural AV fistulas typically required open surgical procedures that involved significant risks and lengthy recovery periods. While surgery remains an important treatment option, the development of endovascular techniques has fundamentally changed how we approach these complex vascular abnormalities.

Today, most people with dural AV fistulas can be treated with an endovascular embolization, a minimally invasive procedure in which surgeons insert 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. The precision achievable with modern endovascular techniques is remarkable, as it allows surgeons to deliver treatment exactly where it’s needed while preserving normal blood vessels and brain tissue.

One of the most significant advantages of endovascular treatment is the dramatic reduction in procedural risks compared to traditional surgery. This translates to lower risks of infection and shorter hospital stays.

Advanced Technology

The field of endovascular therapy continues to evolve rapidly, with new techniques constantly improving our ability to treat complex DAVFs. Modern liquid embolic agents, such as Onyx, for example, provide excellent control and permanence in closing abnormal connections.

Other exciting treatment advances include developments related to catheter technology and imaging. Three-dimensional angiography, for example, now allows surgeons to visualize the fistula and surrounding anatomy with unprecedented clarity, enabling safer and more effective treatment planning.

When Surgery Is Still the Best Option

While I’m passionate about endovascular techniques, I want to emphasize that the best treatment approach is always individualized to each patient. Some dural AV fistulas are better treated with traditional surgical methods, and occasionally, a combination of surgical and endovascular approaches provides the optimal outcome.

This is why it’s crucial to work with a practice that offers the full spectrum of treatment options. At New Jersey Brain and Spine, we have extensive experience in both endovascular and surgical techniques, allowing us to choose the approach that offers each patient the best chance for a complete cure with the lowest risk.

Long-Term Outcomes and Follow-Up: Endovascular Treatment of Dural AV Fistulas 

If you’ve been diagnosed with a dural AV fistula, I want you to know that you’re facing a highly treatable condition with excellent outcomes when managed by experienced specialists. The advances in endovascular therapy have transformed what was once a daunting diagnosis into a condition that can often be cured with a minimally invasive outpatient procedure. The long-term success rates for endovascular treatment of dural AV fistulas are excellent, with follow-up imaging at six months and one year often confirming complete closure of the abnormal connection. 

At New Jersey Brain and Spine, we’re committed to providing you with the most advanced treatment options available while ensuring you feel supported and informed throughout your journey. Our multidisciplinary team has the expertise to handle even the most complex cases, and we take pride in achieving excellent outcomes while prioritizing patient safety and comfort.

Your path to recovery starts with accurate diagnosis and expert treatment planning. Contact us today to schedule a consultation and take the first step toward reclaiming your health and peace of mind.

Dr. Carnevale

As a resident at New York Presbyterian and Memorial Sloan Kettering Cancer Center, Dr. Carnevale honed neurosurgical skills in cerebrovascular disorders, along with spine surgery, neuroendoscopy, and tumors of the brain and spine. He was then selected for the prestigious Endovascular Neurosurgical Fellowship at Weill Cornell – New York Presbyterian Hospital, where he specialized in cerebrovascular techniques focused on treating patients with cerebral aneurysms, carotid-occlusive disease, arteriovenous malformations/fistulas, and various other neurosurgical pathologies.

Dr. Carnevale’s award-winning research focuses on identifying the most optimal minimally invasive alternative approach to neurosurgeries that typically rely on more invasive methods. His unique background grounded in both open and endovascular neurosurgical techniques, enables him to offer patients the most tailored and thoughtful treatment plans based on their specific conditions, desired lifestyles, and care needs.

Case Study: Successful Endovascular Treatment of Dural Arteriovenous Fistula

Jerry, a 45-year-old teacher, presented to our practice with a six-month history of constant pulsatile tinnitus in his right ear that was so severe it prevented him from sleeping. He had seen multiple ENT specialists and audiologists before cerebral angiography revealed a high-grade dural arteriovenous fistula in the right transverse sinus with dangerous retrograde cortical venous drainage. 

Given the high risk of hemorrhage associated with this type of fistula, our team recommended urgent endovascular treatment using a transvenous approach. The procedure was performed under conscious sedation, and we successfully occluded the fistula using detachable coils and Onyx liquid embolic material, achieving complete closure of the abnormal connection. 

Jerry experienced immediate resolution of his pulsatile tinnitus upon awakening from the procedure and was discharged the following day without any complications. Follow-up angiography at six months confirmed complete cure of the fistula with no recurrence, and he successfully returned to full-time teaching with no residual symptoms. 

[name and details have been changed to preserve patient anonymity]

Frequently Asked Questions about Dural Arteriovenous Fistula (dAVF)