Intracranial dural arteriovenous fistula diagnosis [Neurosurgery Wiki]

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====== Intracranial dural arteriovenous fistula diagnosis ======

===== General information =====

Brain CT or MRI without contrast are often normal. [[CTA]] may reveal dilated tortuous vessels corresponding
to enlarged arterial feeders or ectatic draining veins. [[MRA]] may reveal dilated pial vessels,
early prominent venous sinus filling, sinus enlargement or occlusion, and white matter edema
related to venous hypertension. Full 6 vessel cerebral angiography (bilateral ICAs, bilateral ECAs,
bilateral vertebral arteries) is required to establish the diagnosis and to plan treatment.

===== Angiographic classification =====

Several classification systems have been described to characterize DAVFs. The Borden and the Cognard systems have emerged as the most commonly utilized contemporary grading schemes. 

Cortical venous drainage is the defining angiographic feature
that distinguishes benign (low-grade) from aggressive (high-grade) fistulas. (Borden I, Cognard
I, and Cognard IIa are low-grade, all others are high-grade.)