Cranial and Spinal Dural Fistulas

Both cranial and spinal dural fistulas should be evaluated as soon as possible to avoid serious or even life-threatening complications. Houston Methodist’s neurosurgeons and interventional neuroradiologists are highly skilled and specialty trained in diagnosing and treating these types of cerebrovascular conditions.

Cranial Dural Fistulas
Cranial dural fistulas, also called cranial dural arteriovenous fistulas (dAVFs), are abnormal connections between arteries, the outermost layer of the brain (dura) and a draining vein. They are very rare and can form as a result of venous sinus blood clots or traumatic head injury. If left untreated, they can cause hydrocephalus, which is excess fluid in the ventricles of the brain sometimes referred to as “water on the brain,” and potentially life-threatening brain hemorrhage or bleeding.

Symptoms of Cranial Dural Fistulas
Cranial dural fistula symptoms are diverse and depend upon the location and size of the fistula:
  • Headache
  • Vision problems
  • Ringing in the ears
  • Neurological deficits

Diagnosis of Cranial Dural Fistula

Cerebral angiography is usually the best way to diagnose and evaluate a cranial dural fistula. This procedure uses a contrast (dye), along with X-rays to see how blood flows through the brain. A neurosurgeon or interventional neuroradiologist inserts a thin catheter (flexible tube) into an artery in the groin, then carefully guides it to an artery in the neck. The contrast fluid (dye) goes through the catheter and X-rays are taken to show how it flows through the brain. The contrast (dye) helps to show blockages or abnormal flow. 

Magnetic resonance imaging (MRI) or computerized tomography (CT) scan may also be used to diagnose a cranial dural fistula.

Treatment Options for Cranial Dural Fistulas
Treatment options for cranial dural fistulas depend on each patient, the location of the fistula, and the symptoms associated with this condition. Treatment may include endovascular embolization), microsurgery (microsurgical resection), and focused stereotactic radiosurgery. Some patients may need multiple treatments or a combination of treatments to completely eliminate the fistula.

Neurosurgeons and interventional neuroradiologists at Houston Methodist use today’s most advanced technology to treat cranial dural fistulas that would have previously been considered untreatable.

Endovascular embolization 
During an endovascular embolization, a neurosurgeon inserts a tiny catheter (flexible tube) into an artery in your groin, then guides it up to the fistula to block the blood flow between the artery and vein. Platinum coils or other materials, such as surgical glue, may be used to block the blood flow.

Surgery is a better treatment option for some patients. To treat a cranial dural fistula microsurgically, the neurosurgeon performs a craniotomy, removing a piece of bone from the skull to access the brain. A high-resolution, high-magnification microscope helps the surgeon find and treat the fistula. The surgeon places tiny metal clamps on the artery that supplies blood to the fistula to seal off the abnormal blood flow between your artery and vein. The bone flap is replaced at the end of the surgery.

Stereotactic radiosurgery
During stereotactic radiosurgery, a neurosurgeon or interventional neuroradiologist uses precisely focused beams of radiation to destroy the abnormal connection between the affected artery and vein.

Spinal Dural Fistulas
A spinal dural fistula is an abnormal connection between a spinal artery and a draining vein near the spinal cord covering (dura). It is usually found in the lower thoracic (upper back) or lumbar spine (middle to lower back). Spinal dural fistulas cause blood congestion and higher pressure in the spinal cord, which can cause swelling and dysfunction in the spinal cord, including irreversible vein damage and possible paralysis.

There is no known cause for most spinal dural fistulas, although some may be caused by previous surgeries or trauma to the area. Anyone can develop a spinal dural fistula, but they are most common in men ages 50 and older.

Symptoms of Spinal Dural Fistulas
Spinal dural fistulas may not cause any symptoms until they enlarge or cause swelling in the spinal cord. When symptoms do appear, they are diverse:
  • Lower back pain
  • Bladder and bowel problems
  • Impotence (erectile dysfunction)
  • Leg pain, weakness, stiffness, numbness or burning

Diagnosis of Spinal Dural Fistulas

Spinal angiography is usually the best way to diagnosis and evaluate a spinal dural fistula. Each vessel supplying the spinal cord is selectively catheterized and imaged, offering an extremely precise assessment of both the arteries and veins. In some cases, MRI or CT scans may also be used.

Treatment Options for Spinal Dural Fistulas
Treatment options spinal dural fistulas include embolization through the artery (transarterial) and through the vein (transvenous) and microsurgical resection (microsurgery). Some patients may need a combination of treatments to repair the fistula and preserve motor function.

Recovery and Rehabilitation for Cranial and Spinal Dural Fistulas
Many cranial and spinal dural fistulas can be cured and do not recur. However, sometimes additional treatment is needed. The specific recovery and rehabilitation period depends on each patient, and the location and severity of the fistula.

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