Duke's Cerebrovascular Center offers expert diagnosis and treatment for dural and spinal fistulas.

Dural Fistulas

Dural fistulas are abnormal connections between arteries in the brain and the outermost layer of the brain, or dura.

These connections can occur spontaneously, following trauma, or as a result of sinus blood clots.

Depending on their location and size, these lesions may cause ringing in the ears, neurological deficits, and can even predispose patients to potentially devastating brain hemorrhage.

Treatment

At Duke, the goal of treatment is to disrupt the abnormal connection between the arteries and veins. We often use a combination of trans-arterial and trans-venous embolization to disrupt the connections.

In embolization, catheters are placed into the arteries feeding the fistula, and the veins draining the fistula. A combination of glue, onyx, and wire coils are used to block the abnormal connections.

Some patients may require multiple treatments or surgical treatment.

In surgical treatment, our specially trained surgeons perform a craniotomy, using a high-magnification operating microscope and microsurgical technique to identify the fistula. The surgeon then places metallic clips to block the arterial supply to the fistula. 

Before and After

The following images show how dural fistulas appear in the brain before and after treatment.

A 62-year-old female came to the hospital with a sudden headache. She was diagnosed with a subarachnoid hemorrhage caused by a dural fistula.

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Doctors used embolization to treat the dural fistula, and the woman has since recovered with no neurologic deficits.

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Spinal Dural Fistulas

Spinal dural fistulas are abnormal connections between arteries supplying the spinal cord and nerve roots and the veins draining the spinal cord and dural structures.

These lesions can cause severe spinal cord injury, or myelopathy, as a result of venous congestion, vascular steal, or hemorrhage.

Diagnosis

We evaluate all patients with spinal dural fistulas using a sophisticated spinal digital subtraction angiogram, in which each of the vessels supplying the spinal cord is selectively catheterized and imaged.

Treatment

There are different kinds of spinal arteriovenous malformations, and our physicians and surgeons are skilled at providing accurate treatments for each malformation. 

We offer surgical solutions to block the feeding vessel at the point of the fistula, trans-arterial and trans-venous embolization as described above, and treatment focused on relieving pain.

Appointments

For information about scheduling an appointment with a specific doctor, visit the Contact Us page.

Physicians

Physicians offering this service include:

• Britz, Gavin W.
  • Surgery / Neurosurgery
• Enterline, David S.
  • Radiology / Neuroradiology
  • Radiology / Neurointerventional Radiology
• Smith, Tony P.
  • Radiology / Vascular and Interventional Radiology
  • Radiology / Neurointerventional Radiology
• Zomorodi, Ali R.
  • Surgery / Neurosurgery

Locations

This service is available at:

• Duke Health Center at Morreene Road (Neuroscience)
  932 Morreene Road, Durham, NC 27705
• Duke Neurosurgery of Raleigh
  3480 Wake Forest Road, Suite 558, Raleigh, NC 27609
• Duke University Hospital
  2301 Erwin Road, Durham, NC 27710