2025 American Academy of Neurology Abstract Website

Objective:

To describe a rare case of spontaneous cranial dural arteriovenous fistula (DAVF) closure.

Background:

Cranial dural arteriovenous fistulas (DAVFs) are abnormal arteriovenous communication within the dura, frequently requiring intervention due to the risk of neurological complications. Spontaneous closure of DAVFs is a rare phenomenon, with a limited understanding of the mechanisms involved.

Design/Methods:

Results:

A 35-year-old male with a history of chronic alcohol use presented with a generalized tonic-clonic seizure following binge drinking. No focal neurological deficits. imaging showed prominent flow voids in the left frontal sulcal spaces, consistent with a possible AV malformation.

Digital Subtraction Angiography (DSA) confirmed the presence of a DAVF in the anterior cranial fossa, with arterial feeders from the right ophthalmic artery and the left anterior cerebral artery (ACA), draining into an ectatic cortical vein. The patient was initially advised to undergo endovascular closure of the fistula but postponed surgery.
Upon readmission for the scheduled intervention, repeat DSA surprisingly revealed spontaneous closure of the DAVF. No intervention was performed, and the patient was discharged with a plan for continued surveillance and follow-up imaging.

Spontaneous closure of DAVFs is an uncommon occurrence. This may result from venous thrombosis, hemodynamic changes, or vascular remodeling, with cases noted post-angiography due to contrast media effects. In comparison, embolization or surgery is the standard treatment, spontaneous closure calls for individualized management with close monitoring and repeat imaging.

Conclusions:

This case of spontaneous DAVF closure underscores the dynamic nature of vascular malformations and challenges the standard approach to management. Careful clinical and radiological follow- up is crucial in patients with DAVFs, particularly those opting for conservative management. Understanding the mechanisms behind spontaneous closure could inform future therapeutic strategies and optimize patient outcomes.