To review the commonly used Borden-Shucart and Cognard classifications of brain dural arteriovenous fistulas (dAVF). To discussthe natural history of untreated brain dAVF, including clinical symptoms, non-hemorrhagic neurological deficitsand risk of hemorrhagic complications. Review of the multimodality imaging techniques in the diagnosis and grading of brain dAVFs. To presentthe neurointerventional treatment options for brain dAVFs.

Brain dural arteriovenous fistulae (dAVFs) are characterised byabnormal anastomoses between meningeal arteries and dural venous sinuses or cortical veins. Their dural arterial supply and lack of a parenchymal nidus differentiates brain dAVFs from brainarteriovenous malformations. Brain dAVFs are uncommon lesions, composing only 10-15% of all intracranial vascular malformations. Most frequently, brain dAVFs affect patients in their middle-to-later years of life, though have been known to affect children. Neither sex nor family history has been shown to be a reliable risk factor. While the majority of...

Diagnostic Cases Case 1.Patient presenting with right conjunctival injection and severe retro-orbital pain. Post Gad T1FS of the orbits MIP TOF MRA Axial post Gad T1FS image of the orbit (A) and MIP reconstruction of TOF-MRA images (B-C) exquisitely shows the dominant trans-osseous right occipital artery arterial feeder (arrow) and the dilated draining enlarged right lateral mesencephalic vein (arrow head). The dAVF nidus is also shown (*). Axial post Gad T1FS image (A) shows a dAVF (*) along the dural leaflet above the right petrous...

In this review we highlighted the pertinent radiologic features of brain dAVF and imaging features that constitute a high grade dAVF, as these portend to increased risk for adverse neurological outcome. Treatment options were reviewed through case examples, with particular emphasis on interventional neuroradiology techniques.

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