• Standards

They certainly give very strange names to diseases

Plato (427–347 BC)

Seon-Kyu Lee and a formidable panel of authors undertook the laudable task of writing standards and guidelines for the management of an often poorly understood neurovascular entity which they chose to describe as intracranial ‘dural arteriovenous shunts’ (DAVS). I start and end this editorial by commending them on a clear, well-balanced, and concise review. The conclusions and recommendations are sensible, pragmatic and should be widely accepted and applied.

Between these book ends, an editorial always calls for candid critique, and I am in turn honored to be asked to comment on these standards and guidelines. I do so mostly regarding methodology and depth. But first, let me get out of the way the question of nomenclature. Yes, the long and widely used term ‘dural arteriovenous malformation’ (DAVM) may evoke inaccurate comparisons with the brain parenchymal arteriovenous malformations, fundamentally different lesions in terms of etiology, natural history, hemodynamics, pathobiology, and treatment strategies. And the word ‘malformation’ may wrongly imply to some a congenital anomaly, although it need not to. A more trendy term, ‘dural arteriovenous fistula’ (DAVF), unfortunately evokes the view of a single direct arteriovenous connection, belying the plexiform …