Endovascular Treatment of Anterior Cranial Fossa Dural Arteriovenous Fistula

Anterior cranial fossa (ACF) dural arteriovenous fistula (DAVF) is a rare lesion among cerebral DAVFs. This lesion shows significant bleeding risk because of the angioarchitecture, involving direct leptomeningeal retrograde venous drainage, as a nonsinus-type DAVF. Over the years, direct surgery has been considered the primary treatment for ACF DAVF, offering favorable clinical outcomes compared to a low complete obliteration rate with endovascular treatment and the relatively high risk of blindness due to central retinal artery occlusion with transophthalmic artery embolization. In recent years, however, significant improvements in DSA and 3D reconstruction imaging quality have allowed a much more precise understanding of the angioarchitecture of the shunt and vascular access route. In addition, advances in endovascular devices, including catheters and embolic materials, have facilitated microcatheter navigation into more distal vessels and more reliable closure of the fistulous point. Supported by such technological innovations, endovascular approaches to the treatment of ACF DAVF have been becoming successful first-line treatments. This article reviews the evolution of treatment strategies and the current status of endovascular treatment for ACF DAVF, with a particular focus on transarterial embolization.