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Year : 2020  |  Volume : 4  |  Issue : 1  |  Page : 41-42

Dural arteriovenous fistula classifications: An overview

Department of Medicine, Federal University of Santa Maria, Santa Maria, Rio Grande do Sul, Brazil

Date of Submission31-Dec-2019
Date of Acceptance19-Jan-2020
Date of Web Publication12-Mar-2020

Correspondence Address:
Dr. Jamir Pitton Rissardo
Rua Roraima, Santa Maria, Rio Grande do Sul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/LJMS.LJMS_74_19

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How to cite this article:
Rissardo JP, Fornari Caprara AL. Dural arteriovenous fistula classifications: An overview. Libyan J Med Sci 2020;4:41-2

How to cite this URL:
Rissardo JP, Fornari Caprara AL. Dural arteriovenous fistula classifications: An overview. Libyan J Med Sci [serial online] 2020 [cited 2023 Feb 3];4:41-2. Available from: https://www.ljmsonline.com/text.asp?2020/4/1/41/280570

Dear Editor,

We read the article entitled, “Unusual Cause of Seizure” on the esteemed “Libyan Journal of Medical Sciences” with great interest. Elhassan Eltahir et al. reported a case of an elderly male presenting with seizure. A cranial magnetic resonance angiography revealed the superior sagittal sinus dural arteriovenous fistula. He underwent a successful catheter embolization of the fistula. Antiepileptic drugs were started, and the subject was seizure-free.[1]

Cranial dural arteriovenous fistulas are abnormal vascular malformations of the cranial dura, which involve connections between meningeal arteries draining into veins adjacent to dural venous sinuses.[2] The etiological factors of this shunt are traumatic brain injury, surgery, and sinus thrombosis. Thrombosis appears to be the most common predisposing factor.[1] In this context, there are some classification systems based on angiographic findings. The first grading method was proposed by Djindjian and Merland.[2] Today, in clinical practice, we currently use Borden and Cognard classifications. These scales are important because they can estimate the annual hemorrhagic risk of vascular malformation.[3] Here, we would like to provide [Table 1] and [Figure 1] to better understand these systems.[2],[3],[4]
Table 1: Dural arteriovenous fistulas classification systems

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Figure 1: Schematic diagram of the Borden (B) and Cognard (C) dural arteriovenous fistula classification systems. (a) B1–CI; (b) B1–CIIa; (c) B2–CIIb; (d) B2–CIIa + b; (e) B3–CIII; (f) B3–CIV; (g) CV. (1) Artery; (2) cortical vein; (2a) ectasic cortical vein; (3) sinus; (4) thrombus; (5) spinal vein

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The majority of these fistulas are believed to be asymptomatic due to angiographic epidemiological studies;[2] however, when they are symptomatic, some features are pulsatile tinnitus, occipital bruit, visual impairment, and papilledema.[4] An interesting fact is that some individuals present with headache due to the inflammation of dural pain fibers, which based on this sole symptom is difficult to diagnosis cranial dural arteriovenous fistulas in the clinical practice and needs to have high clinical suspicion;[3] the pain is characteristic continuous with some lateralization but can be bilateral.[2]

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There are no conflicts of interest.

  References Top

Elhassan Eltahir RM, Sadik N, Salem K. Unusual cause of seizure. Libyan J Med Sci 2019;3:141-3.  Back to cited text no. 1
Aoun RJ, Sattur MG, Pines AR, Halasa TK, Hamade YJ, Zammar SG, et al. Cranial dural AV fistulas: Making sense of who to treat and how. Controversies in Vascular Neurosurgery. Basel, Switzerland: Springer; 2016. p. 195-218.  Back to cited text no. 2
Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 1995;82:166-79.  Back to cited text no. 3
Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, et al. Cerebral dural arteriovenous fistulas: Clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995;194:671-80.  Back to cited text no. 4


  [Figure 1]

  [Table 1]


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