History of Management of Dural Arteriovenous Malformations in Children

Understanding of Disease

  • 1873–first described: In 1873 Rizzoli described the first cranial DAVF as an AVM that involved the dura mater(23).
  • 1931–first angiographic description: In 1931 Sachs made the first angiographic description of a cranial DAVF.(24)
  • 1962–first description arterial ligation: In 1962 Verbiest first attempted to treat one of these lesions by arterial ligation(30).
  • Evolving thoughts on pathogenesis: Initially authors attributed the etiopathogenesis of these mostly acquired vascular malformations to the arterial side. Nonetheless, attention slowly shifted to the venous system, and it is now believed that after venous outlet obstruction occurs, angiogenesis, venous hypertension and opening of dormant venous channels in the dura can connect external carotid circulation to the venous circulation, which acts as a recruiting system and creates the DAVFs(12,28).

Technological Development

  • Interventional neuroradiology: With the expansion of neurointerventional surgery in the 1990s, most cranial DAVFs are now treated endovascularly. Open surgery still has a role, however, in certain locations such as anterior fossa, and in patients in whom endovascular treatment is not feasible or successful.

Surgical Technique

  • Microsurgery: With the introduction of the surgical microscope, microsurgery became the mainstay technique to treat cerebrovascular disorders (33). Open surgery, when used, has shifted from extensive sinus skeletonization, sinus packing and dura resection to fistulous point disconnection.
  • History of Management of Dural Arteriovenous Malformations in Children Its introduction has helped in understanding and sometimes localizing the fistulous connection(25). These imaging techniques can be used to confirm fistula obliteration.