Zerebrale dAVF (durale arteriovenöse Fisteln) können asymptomatisch sein, aber auch
schwere neurologische Defizite verursachen. Die Therapieentscheidung erfordert deshalb
genaue Kenntnisse dieser Malformationen. Die vorliegende Arbeit beschreibt das Erscheinungsbild
der intrakraniellen dAVF in Klinik und Bildgebung, beleuchtet die zu einer dAVF führenden
Pathomechanismen und geht auf Indikationen und Möglichkeiten der Therapie ein.
Abstract
Dural arteriovenous fistulas (DAVF), also referred to as dural arteriovenous malformations,
account for 10 – 15 % of all intracranial vascular malformations with AV-shunt. DAVF
are pathologic shunts between dural arteries and dural venous sinuses, meningeal or
cortical veins. Most frequently, DAVF are located within the wall of the transverse,
sigmoid, cavernous, sagittal superior sinus or within the cerebellar tentorium. Whereas
in many cases no underlying pathomechanism is found, thrombosis of venous vessels,
inflammatory processes and trauma have been listed as underlying causes. Depending
on localization of the fistula, shunt volume, and venous drainage pattern, the clinical
presentation of patients ranges from asymptomatic to severe neurological deficits.
Dural AVF can be graded using the classifications of Cognard et al. or Borden et al.,
both of which stratify the lesions with special emphasis on venous drainage patterns,
as cortical venous drainage has been found to be associated with an increased risk
for intracranial haemorrhage. The indication to treat a DAVF thus mainly depends on
the patients’ clinical presentation as well as the venous drainage pattern. Carotid
cavernous fistulas likewise are DAVF, but since more frequently they are traumatic,
they are categorized according to Barrow et al. Treatment options include (transvenous
and/or transarterial) endovascular approaches, neurosurgery, and radiosurgery. A combination
of the afore- mentioned treatment modalities is feasible. Thus, treatment of DAVF
should be performed in a neurovascular center with close interdisciplinary cooperation
of a team of neuroradiologists, neurosurgeons, and radiotherapists and neurologists.
Schlüsselwörter Zerebrale durale arteriovenöse Fistel - Klassifikation - Pathomechanismus - Bildgebung
- Therapie
Keywords cerebral dural arteriovenous fistula - classifications - pathomechanism - imaging
techniques - therapy
