- Abnormal connection between arterial supply and dural venous sinuses
- Acquired deficits not congenital like AVMS and potential cause of ICH and SAH
- Causes include head injury, open surgery and Cerebral venous sinus thrombosis.
- These "fistulae" are extra axial direct connections between arterial flow and dural venous sinuses.
- The result is flow, shunting, pressure effects and venous congestion and haemorrhage.
- One example of this is the carotid-cavernous sinus shunts that arise with chemosis and scleral injection and an audible bruit.
- Related to Cavernous sinus behind the eye: chemosis, reduced acuity, bruit, swelling of the eye.
- Related to Transverse/sigmoid sinus behind ear: pulsating noise (tinnitus). Stroke like symptoms, seizure like activity, headaches.
- Possibly asymptomatic, Dural pain fibres can lead to headache.
- Seizures, bruits, headaches, stroke like episodes
- Signs of increased intracranial pressure and bleeding.
- Diagnosis is by CTA/MRA/DSA.
- Annual bleed risk is difficult to determine but felt to be less than 5% per annum.
- Treatment options include conservative, endovascular embolisation using N-butyl-cyanoacryalate glue or other substance or surgery.