Dural arteriovenous fistula in the brain. How to choose between open brain surgery, radiosurgery, or endovascular treatment? Leading cerebrovascular neurosurgeon. Brain Dural Arteriovenous Fistula, BDAVF. There are many treatment options for brain dural arteriovenous fistula. Dr. Anton Titov, MD. They depend on several important clinical factors. Dr. Anton Titov, MD. How do you decide on the best treatment for dural fistulas in the brain? Dr. Mika Niemela, MD. That depends on the BDAVF location. Surgical treatment is the best for Dural fistulas in the anterior fossa. On average, for all the brain dural AV fistulas, endovascular treatment is better. Endovascular treatment is the treatment method of choice in most of brain dural fistulas. The only exception is the anterior skull base dural AV fistulas. There surgery is still the number one treatment choice. You can also do radiosurgery or combined treatment in some of the dural AV fistulas. Dr. Mika Niemela, MD. A decision on treatment or observation depends on the symptoms. Surgical treatment is done for a Dural AV fistula that has bled. BDAVF may have cortical reflux from venous reflux. This predisposes dural fistula more to rupture. We treat more actively DVAF with cortical reflux. Sometimes a brain dural AV fistula has a cortical reflux. Dr. Anton Titov, MD. Then you treat it more aggressively and early. Exactly! Brain dural fistula might not bled yet. Dr. Mika Niemela, MD. But the patient could have tinnitus or disturbing bruit in the ear. Then we treat dural AV fistula in the brain.