Abstract:
A cranial dural arteriovenous fistula is a vascular malformation where meningeal arteries connect directly to
dural or cortical veins. It can occur at any age and may cause hemorrhages and severe neurological deficits.
Early diagnosis and accurate classification are essential for the optimal approach. To review the imaging,
diagnostic, and therapeutic aspects of dural arteriovenous fistulas (dAVFs), highlighting the role of the
multidisciplinary team in their management. A systematic literature review was conducted using PubMed,
Scopus, and Web of Science databases, covering the period from 2010 to 2025. Original studies, metaanalyses, and relevant guidelines on the diagnosis, classification, and treatment of dural fistulas were
included. Fistulas are most frequently located in the transverse and sigmoid sinuses. Clinical risk assessment
uses the Cognard and Borden classifications. Definitive diagnosis is made by angiography, which also aids in
treatment planning. The fistula’s location, flow, angioarchitecture, and drainage help predict clinical
outcome. Treatment is based on symptoms and the risk of hemorrhage or intracranial hypertension.
Endovascular therapy with ONYX is effective in over 85% of cases, and fistulas with retrograde cortical
drainage require prompt intervention. There is no clear consensus on managing asymptomatic fistulas.
Dural arteriovenous fistulas are rare and lack universal guidelines. Early diagnosis and personalized
treatment, especially endovascular, can prevent severe complications. A multidisciplinary approach is
essential for timely diagnosis and effective management.
