Embolization of a dural arteriovenous fistula (DAVF)

Treatment options

The USZ offers several treatment options for DAVF:

• Endovascular embolization: The most common treatment is endovascular embolization. In this minimally invasive procedure, we access and treat the malformation over the arteries and veins. During the procedure, we insert plastic tubes (catheters) through the femoral artery and vein and guide them into the vessels affected by DAVF. We then inject embolization agents through the tubes or introduce material that occludes the vessels of the malformation.
• Neurosurgical treatment: In some cases, it is possible to occlude the DAVF neurosurgically.
• Conservative treatment: In certain cases, conservative treatment (without surgery) is preferred. We select this option after thoroughly weighing the risks of disease versus the risks/success of invasive treatment.

Advantages and disadvantages

• Treatment of a Dural AV fistula is indicated if it causes symptoms (e.g. pulse synchronous tinnitus, headache) and/or if there is an increased risk for cerebral hemorrhage. Proper treatment helps avoid these risks.
• A “benign” dural AVF does not necessarily need to be treated if the associated risks of cerebral hemorrhage or brain damage are insignificant and if the patient has no symptoms.
• The alternatives to endovascular treatment are neurosurgical intervention or conservative therapy combined with closely observing the DAVF.

Course of treatment

Treatment starts with the diagnosis and the decision to use minimally invasive methods. After discussing this with you during a consultation, we will schedule a timely appointment, which is in keeping with the urgency of your case and your special wishes.

The treatment requires a hospital stay of three to four days. You will arrive the morning before the procedure and we will assess your current status and make the final preparations. We will use this opportunity to answer any questions you might have. On the day of the procedure, you will be taken from the ward to one of our two operating rooms, where the surgical team will meet you and perform the procedure.

Aftercare

Immediately after the procedure, you will be examined to make sure everything went well. We will then transfer you to a specialized monitoring ward where you will be cared for until the next day. On the following day, you will undergo a magnetic resonance examination to assess the surgical outcome and rule out any complications. Normally, you will then return to the standard ward and after another one or two days you will consult with a specialist and can then go home. During this last consultation, we will schedule appointments for further check ups.