Challenging Cranial Arteriovenous Fistulas

Arteriovenous fistulas, both pial and dural, are neurovascular malformations which frequently have a poor natural history. Their treatment can be either endovascular or neurosurgical. The evolution of neurointerventional materials and techniques extended the indication for endovascular treatment to most of the arteriovenous fistulas.

A clear understanding of the vascular anatomy of arteriovenous fistulas is essential in order to be able to treat them. Familiarity with neurovascular techniques and devices is also important for choosing the proper treatment strategy in each case.

In this chapter the different types of fistulas are discussed with the most appropriate treatment strategies in each situation, also taking into consideration the neurovascular materials now available.

Keywords: Dural arteriovenous fistula, endovascular treatment, pial arteriovenous fistula.