Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage

Radiology. 1995 Mar;194(3):671-80. doi: 10.1148/radiology.194.3.7862961.


Purpose: To review the symptoms and progression of dural arteriovenous fistulas (AVFs) and correlate the findings with various angiographic patterns.

Materials and methods: Patterns of venous drainage allowed classification of dural AVFs into five types: type I, located in the main sinus, with antegrade flow; type II, in the main sinus, with reflux into the sinus (IIa), cortical veins (IIb), or both (IIa + b); type III, with direct cortical venous drainage without venous ectasia; type IV, with direct cortical venous drainage with venous ectasia; and type V, with spinal venous drainage.

Results: Type I dural AVFs had a benign course. In type II, reflux into the sinus induced intracranial hypertension in 20% of cases, and reflux into cortical veins induced hemorrhage in 10%. Hemorrhage was present in 40% of cases of type III dural AVFs and 65% of type IV. Type V produced progressive myelopathy in 50% of cases.

Conclusion: This classification provides useful data for determination of the risk with each dural AVF and enables decision-making about the appropriate therapy.

MeSH terms

  • Arteriovenous Fistula / classification
  • Arteriovenous Fistula / complications
  • Arteriovenous Fistula / diagnostic imaging*
  • Blood Flow Velocity
  • Central Nervous System Diseases / etiology
  • Cerebral Angiography
  • Cerebral Arterial Diseases / classification
  • Cerebral Arterial Diseases / complications
  • Cerebral Arterial Diseases / diagnostic imaging*
  • Cerebral Hemorrhage / etiology
  • Cerebral Veins* / diagnostic imaging
  • Cerebrovascular Circulation / physiology
  • Child
  • Dura Mater / blood supply*
  • Female
  • Humans
  • Infant, Newborn
  • Male
  • Middle Aged
  • Pseudotumor Cerebri / etiology
  • Risk Factors
  • Sex Factors