Do you sometimes hear a noise inside your head? Or do you often have headaches? You may think that these things are normal, but sometimes there is something behind this that needs some attention. That is what is called a dural arteriovenous fistula (dAVF) . Let's talk about it simply.
What is dural arteriovenous fistula (dAVF)?
Simply put, there is a thin protective membrane around our brain and spinal cord. This is what we call the dura mater . It's like the back cover of a book.
Now look, we have a network of blood vessels to carry blood to every part of our body. Arteries carry clean, oxygen-rich blood from the heart to all the other organs, including the brain. Veins carry used, oxygen-poor blood back to the heart. Between these arteries and veins, there is a very fine network of blood vessels, which we call capillaries . These capillaries control the flow of blood and properly distribute blood to the organs.
Now, in this condition called fistula , an artery connects directly to a vein, without the intermediate system of capillaries. Imagine it as if a large water pipe were suddenly connected to a small pipe. Then, blood rushes into that vein at high speed and under high pressure. A vein is not used to that much blood and that much pressure.
So, this so-called dural arteriovenous fistula (dAVF) is an abnormal connection between an artery and a vein inside the dura mater, the membrane that surrounds the brain. Sometimes your doctor may also call this a dural arteriovenous malformation .
This abnormal connection can cause blood pressure inside the blood vessels to become unstable, the shape of the blood vessels can change, and the blood may not flow in the direction it should. Sometimes, a blood vessel can burst because it can't handle the high pressure. If that happens, it can cause life-threatening bleeding.
How common is this condition?
Actually, this condition (dAVF) is not that common. For example, in the United States, it is said to occur in a rate of between 0.15 and 0.19 per 100,000 people per year. That means it is very rare.
Is this (dAVF) a serious condition?
Here's how it works. Some (dAVF) are very mild and don't cause any major health problems. However, some are very serious and can be life-threatening. Especially if a blood vessel bursts and bleeds, as mentioned above, it can damage brain tissue and cause a stroke .
The most important thing is to see a doctor as soon as possible if you have any symptoms. If you or someone close to you experiences symptoms of a stroke (e.g., weakness on one side, slurred speech, loss of consciousness), you should immediately call 911 or the nearest emergency room.
What are the symptoms of (dAVF)?
Sometimes you may not have any symptoms even if you have a (dAVF) . But if you do have symptoms, they can range from mild to severe. Symptoms also vary depending on where in the brain the fistula is located. Look for these:
- Headache: It may not be just a regular headache, but a new type of headache that is sometimes a little more severe.
- Nausea and vomiting: These can occur, especially with headaches.
- Pulsatile tinnitus: This is a very specific symptom. It is like a "ringing" or "buzzing" sound in your ear, similar to your heartbeat. Some people also describe it as a "ringing sound in your ear."
- Vision changes: Sudden blurring of vision, double vision, or a feeling of vagueness in vision.
- Speech or language difficulties: Slurring of words, as if unable to speak.
- Losing balance when walking, having difficulty controlling limbs when working.
- Muscle weakness or numbness: A feeling of numbness or weakness on one side of an arm, leg, or face.
- Pain in the face, arms, or legs.
- Memory loss.
- Unusual feelings or sensations.
These symptoms are usually caused by bleeding within your brain . So if you have these symptoms, see a doctor immediately.
What are the causes of this (dAVF)?
Doctors still don't know exactly what causes dAVF . However, many scientists believe that it can be caused by head trauma . It can appear years after the injury. Some studies suggest that it is related to a blockage in the blood vessels that carry blood to the brain. This blockage can be caused by a disease, an accident, or other event. For example:
- Blood clot (Thrombosis).
- Traumatic brain injury.
- Brain surgery, such as a craniotomy.
Rarely, someone can be born with this (dAVF) , but it is not hereditary. This condition is still being researched.
Who is at higher risk of developing this (dAVF)?
This condition (dAVF) can develop at any age, but it is most common in adults between the ages of 40 and 60 .
What are the possible complications of (dAVF)?
Complications caused by this (dAVF) can sometimes be life-threatening. The main ones are:
- Bleeding within the brain tissue (hemorrhage).
- Bleeding inside the skull, but outside the brain (Subdural hematoma).
- Bleeding between the brain and the protective membrane surrounding it (Subarachnoid hemorrhage).
- Increased pressure inside the skull (intracranial pressure).
- Seizures.
- Stroke.
Imagine, what would happen if a small tap connected to the large pipe that brings water to our house's water tank suddenly came loose? There would be water all over the house. That's what would happen if a blood vessel burst inside the brain. That's why this is so dangerous.
How is this (dAVF) condition diagnosed?
A doctor diagnoses this condition (dAVF) after these steps:
- Physical examination.
- A test related to the nervous system.
- Special imaging tests.
When performing these tests, your doctor will ask you about your symptoms and details about your previous illnesses.
Sometimes, you may not have any symptoms and it may be discovered by chance when you have an imaging test of your brain or spine for another reason.
Special tests that help detect (dAVF)
A doctor can take a good picture of your blood vessels and use tests like these to see if you have this (dAVF) :
- An MRI (Magnetic Resonance Imaging) scan or an MRA (Magnetic Resonance Angiography) scan.
- CT Angiography (CTA - Computed Tomography Angiography) test.
Both of these tests are painless and do not cause much discomfort. They allow your doctor to get a clear picture of the blood vessels in your nervous system, which may be causing your symptoms.
If an imaging test like this (dAVF) raises concerns, your doctors will talk to you about another specialized test called a cerebral angiogram .
A cerebral angiogram is a non-invasive test that can produce the best, clearest images of the blood vessels in your brain. In this test, doctors insert a very small tube – we call it a catheter – into a vein in your arm, wrist, or upper leg, and thread it through a vein in your neck to the blood vessels in your brain. Then, through the catheter , a special fluid (contrast agent) is injected into your body. When it mixes with your blood, it can be seen on X-rays as the blood flows through the arteries in your brain and returns from the veins. This allows doctors to determine exactly what the dAVF looks like and what the best treatment is for it.
Is there a cure for this condition (dAVF)?
Yes, treatment can remove this fistula and restore normal blood flow in the veins. This can reduce or prevent new symptoms and complications.
How is (dAVF) treated?
The main goal of this (dAVF) treatment is to eliminate the abnormal connection (fistula) between the artery and vein. There may be treatment options such as:
- Surgery: Open surgery can be performed to remove the abnormal connection (fistula) in the affected blood vessel.
- Endovascular embolization: In this, as mentioned earlier, a very small tube (catheter) is passed through one of your arteries, to where the fistula is, and it is closed off. It's like putting a seal on a leak.
- Stereotactic radiosurgery: This is a type of radiation therapy. In this, very targeted beams of radiation are directed at the affected blood vessel where the fistula is connected, blocking it.
Your doctor will determine the best treatment plan for you. This will depend on many factors, including the nature of the (dAVF) , your general health, symptoms, and your risk of bleeding or complications.
If you have no symptoms, your doctor may not treat you right away, but may monitor you regularly to prevent complications.
What is the prognosis of (dAVF)?
Your prognosis depends on many factors, such as the location of the fistula and whether it is bleeding. If it is detected and treated early, the prognosis is usually good. Unfortunately, some (dAVF) can cause permanent or life-threatening complications. If such complications occur, there are aftercare and support services to help, such as physical therapy , occupational therapy , and speech therapy .
Your doctor is the person who can give you the most accurate outlook based on your condition.
Survival Rate from (dAVF)
Because this condition (dAVF) is so uncommon, research into survival rates is still ongoing. Current studies suggest that the annual mortality rate for this condition is between 11% and 19%. This means that in some cases, the annual survival rate could be as high as 80%.
Can this (dAVF) condition be prevented?
There is no known way to prevent this condition (dAVF) . However, you can reduce your risk by controlling underlying health conditions (such as blood clotting disorders) that can lead to this condition. You can also protect yourself from head injuries by wearing proper protective equipment when playing sports and other activities.
What time should I see a doctor?
See a doctor if you experience any of these symptoms:
- A sudden, severe headache.
- Muscle weakness or numbness.
- Changes in your speech, walking, balance, or vision.
- New onset, ringing in the ears (Pulsatile tinnitus).
If you or someone close to you experiences symptoms of a stroke (e.g., weakness on one side, slurred speech, loss of consciousness), you should call 911 or the nearest emergency room immediately. Time is of the essence!
What questions should I ask my doctor?
When you see a doctor, it's a good idea to ask questions like these:
- Where is this fistula located?
- What treatment option do you recommend?
- Do I really need surgery?
- What are the side effects of this treatment?
- Can this fistula develop again after treatment?
- How long will it be before I have to come back for the tests?
Finally, take-home message
This condition, called dural arteriovenous fistula (dAVF), can have a major or minor impact on your life. In some cases, it can be a minor problem that can be easily managed under the supervision of a doctor. However, if not diagnosed and treated promptly, it can lead to permanent or life-threatening complications.
If you have any symptoms or are concerned about something, call a doctor or emergency room right away. There are treatments that can help remove the fistula and restore blood flow to all parts of your body. There are a variety of treatment options, not all of which require open surgery. Your medical team will evaluate your symptoms and determine the best treatment plan for you to prevent complications.
You know your health best. So if you notice any changes in your body, don't ignore it. Taking quick action can prevent many serious conditions.
` Dural arteriovenous fistula, dAVF, cerebral blood vessels, headache, pulsatile tinnitus, cerebral hemorrhage, stroke
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