Endovascular Management of Intracranial Dural AVFs: Transvenous Approach

Area of Science:

• Neurology
• Vascular Surgery
• Interventional Radiology

Background:

• Intracranial dural arteriovenous fistulas (dAVFs) require effective management strategies.
• Endovascular techniques are evolving for treating complex dAVFs.
• Transvenous embolization is gaining prominence as a therapeutic option.

Purpose of the Study:

• To review the endovascular management of intracranial dural AVFs using transvenous embolization.
• To highlight the efficacy and safety of transvenous embolization for specific dAVF locations.
• To discuss the advantages of transvenous embolization over transarterial approaches.

Main Methods:

• Review of transvenous embolization techniques for intracranial dural AVFs.
• Analysis of treatment outcomes in ventral dural AVFs (cavernous sinus, hypoglossal canal).
• Evaluation of transvenous embolization in high-risk lateral epidural dAVFs (petrous, ethmoid regions).

Main Results:

• Transvenous embolization is the first-line approach for ventral dAVFs and increasingly used for high-risk lateral dAVFs.
• Angiographic cure rates of 80%-90% are achievable in ventral locations using coils ± ethylene-vinyl alcohol copolymer.
• Reduced risk of ischemic cranial neuropathy and brain infarction compared to transarterial methods.

Conclusions:

• Transvenous embolization is a highly effective endovascular treatment for intracranial dural AVFs, especially in ventral and specific lateral locations.
• This approach offers significant advantages in reducing neurological complications.
• Consider transvenous embolization for dAVFs near vasa nervosum or with extracranial-intracranial anastomoses.