Abstract
Dural arteriovenous shunts (DAVSs) are acquired lesions. The pathological shunts are located into the dura itself, fed by dural arteries, and drain into dural sinuses or into cortical veins. It is this venous drainage that creates the clinical symptomalogy. Hemorrhage, seizures, progressive neurological deficits are only seen in the case of DAVSs with cortical venous drainage.
Pulsatile tinnitus is most often encountered in DAVSs with sinusal drainage, mainly into the transverse sinus. Brain risks in DAVS can also be described: associated pial supply and shunts and associated aneurysms. CT and MRI may be negative in DAVS with pure sinusal drainage.
Angiography represents the best imaging modality in order to confirm the diagnosis and study the arterial and venous vascularization of adjacent healthy territories. It offers also a planification of the therapeutic approach of DAVS that is considered mainly (in first intention) endovascular. The best results of embolization are obtained with liquid agents (Histoacryl*).
Trans-arterial approach is used in first intention but trans-venous therapy has been used with good results in particular indications.
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