Abstract
When treating dural arteriovenous fistulas (DAVF), it is recognized that the disease course depends on the disturbance of the cerebral blood flow such as cortical venous drainage and venous congestion. Recent reports suggested that symptomatology is also an important factor affecting the natural history of this pathology. Decision tree analysis used in data mining identified factors associated at different levels of significance (symptomatology>cortical venous drainage>lesion location) with an aggressive presentation in patients with DAVF. These factors can help to predict the future development of intracranial hemorrhage/infarction in DAVF patients. Therefore treatment indication should be carefully determined based upon various factors to best affect the natural course.
Most of DAVFs can be treated by endovascular technique except for some specific lesion locations including the craniocervical junction and anterior cranial fossa. Trans-venous embolization which is results in the outlet occlusion of DAVF is an established therapy with high curability and low morbidity. Transarterial and trans-fistulous embolization with NBCA or Onyx can also be expected with higher curability, although all of the possible procedure-related complications are not yet fully elucidated.
