TY - JOUR T1 - Standard and Guidelines: Intracranial Dural Arteriovenous Shunts JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 516 LP - 523 DO - 10.1136/neurintsurg-2015-012116 VL - 9 IS - 5 AU - Seon-Kyu Lee AU - Steven W Hetts AU - Van Halbach AU - Karel terBrugge AU - Sameer A Ansari AU - Barb Albani AU - Todd Abruzzo AU - Adam Arthur AU - Michael J Alexander AU - Felipe C Albuquerque AU - Blaise Baxter AU - Ketan R Bulsara AU - Michael Chen AU - Josser E Delgado Almandoz AU - Justin F Fraser AU - Don Frei AU - Chirag D Gandhi AU - Don Heck AU - Muhammad Shazam Hussain AU - Michael Kelly AU - Richard Klucznik AU - Thabele Leslie-Mazwi AU - Ryan A McTaggart AU - Philip M Meyers AU - Athos Patsalides AU - Charles Prestigiacomo AU - G Lee Pride AU - Robert Starke AU - Peter Sunenshine AU - Peter Rasmussen AU - Mahesh V Jayaraman AU - on behalf of the Standard and Guidelines Committee for the Society of Neurointerventional Surgery Y1 - 2017/05/01 UR - http://jnis.bmj.com/content/9/5/516.abstract N2 - Intracranial dural arteriovenous shunts (DAVS), also known as dural arteriovenous fistulas or dural arteriovenous malformations, are abnormal connections between dural (and occasionally pial) arteries and the veno vasora within the dura mater, comprising the walls of the dural sinuses, the leptomeningeal (bridging) veins, or the transosseous emissary veins within or adjacent to the dura mater. DAVS are rare, accounting for about 5–15% of intracranial vascular malformations.1 ,2 Although incompletely understood, DAVS are thought to be acquired lesions3 resulting from dural sinus or cortical venous thrombosis, possibly precipitated by hormonal changes, hypercoagulability states, trauma, or a combination of these factors.4–6 The clinical implications of intracranial DAVS are directly associated with its venous drainage pattern. For example, intracranial DAVS can cause either intracranial hemorrhages or non-hemorrhagic neurologic events such as regional or global venous congestive encephalopathy.The aims of this document are (1) to review existing knowledge about the natural history, diagnostic methodology, and treatment modalities/techniques for DAVS; and (2) to provide recommendations on management strategies for intracranial DAVS using evidence-based medicine approaches when possible but, of necessity, relying frequently on expert opinion concerning this rare disease. Recommendations follow the American College of Cardiology/American Heart Association (ACC/AHA) Classification of Recommendation/Level of Evidence (COR/LOE) and the definition of classes and levels of evidence used in the AHA/American Stroke Association (AHA/ASA) recommendations (tables 1 and 2).View this table:In this windowIn a new windowTable 1 ACC/AHA Classification of Recommendations and Level of Evidence (COR/LOE)View this table:In this windowIn a new windowTable 2 Definition of classes and levels of evidence used in AHA/ASA recommendationsGiven the rarity of DAVS and the challenge of diagnosing them with non-invasive tools, the natural history of intracranial DAVS is not completely understood. There are few data on the progressive enlarge of DAVS over time with respect to recruitment or enlargement of arterial feeders or appearance of de novo fistulas over time. … ER -