"Dural arteriovenous fistulas are usually acquired and in most instances are idiopathic 6. In patients with a documented antecedent cause, most occur as a result of neovascularisation induced by a previously thrombosed dural venous sinus (typically the transverse sinus). Other causes include trauma and previous craniotomy. It is likely that at least some patients with apparently idiopathic fistulae had prior asymptomatic thrombosis, particularly as inherited prothrombotic conditions (e.g. antithrombin, protein C, and protein S deficiencies) have been associated with the development of dural arteriovenous fistulas 6."
"In patients with retrograde leptomeningeal venous drainage, oedema is present in approximately half of the patients, although it may also be seen in patients who do not have retrograde leptomeningeal drainage on angiography 3. These regions of white matter oedema may also enhance and are indicative of an aggressive fistula with a high rate of haemorrhage 3."
"Catheter digital subtraction angiography demonstrates arteriovenous shunting most typically with multiple feeders and with no intervening nidus. DSA remains the gold standard in both diagnosis and accurate classification of dural arteriovenous fistulas, allowing not only systematic evaluation of feeding vessels (and thus planning for potential intervention), but also demonstrating the presence and extent of retrograde leptomeningeal venous drainage. Due to often extensive supply, a six vessel selective angiogram is required (bilateral ICA, ECA and vertebral artery injections)."
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"Catheter digital subtraction angiography demonstrates arteriovenous shunting most typically with multiple feeders and with no intervening nidus. DSA remains the gold standard in both diagnosis and accurate classification of dural arteriovenous fistulas, allowing not only systematic evaluation of feeding vessels (and thus planning for potential intervention), but also demonstrating the presence and extent of retrograde leptomeningeal venous drainage. Due to often extensive supply, a six vessel selective angiogram is required (bilateral ICA, ECA and vertebral artery injections)."