32 Sigmoid dural arteriovenous fistulaDural arteriovenous fistula (DAVF)transverseDural arteriovenous fistula (DAVF)sigmoidArteriovenous fistula (AVF)duraltransverseArteriovenous fistula (AVF)duralsigmoidTransverse and Sigmoid Dural Arteriovenous Fistula

Dural arteriovenous fistulae (DAVFs) are arteriovenous shunts located within the dural leaflets and constitute 10 to 15 % of intracranial vascular malformations. Transverse and sigmoid DAVFs are the most common locations for DAVF. Clinical presentations include pulsatile tinnitus, intracranial hemorrhage, and neurological deficits. Currently, both Borden and the Cognard classifications of DAVF have gained widespread popularity, and are based on patterns of venous drainage from the dural fistulae. Low-risk DAVFs (Borden I or Cognard I, IIa) have no retrograde leptomeningeal venous drainage and are associated with a relatively benign natural history.1,​2 In contrast, DAVF with retrograde leptomeningeal venous drainage (Borden II, III or Cognard IIb, III, IV) are associated with an increased risk of hemorrhage and neurological deficits. Treatment is therefore recommended for high risk DAVF, and its objective is to completely obliterate the arterialized draining vein. Available modalities include microsurgery, endovascular embolization (via transarterial or transvenous approaches), or radiosurgery. This chapter outlines the natural history of DAVF, and the indications and surgical techniques for treatment of transverse and sigmoid DAVF.