A dural arteriovenous fistula (DAVF) or malformation is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus. Signs and symptoms
The most common signs/symptoms of DAVFs are:
Pulsatile tinnitus
Occipital bruit
Headache
Visual impairment
PapilledemaPulsatile tinnitus is the most common symptom in patients, and it is associated with transverse-sigmoid sinus DAVFs. Carotid-cavernous DAVFs, on the other hand, are more closely associated with pulsatile exophthalmos. DAVFs may also be asymptomatic (e.g. cavernous sinus DAVFs). Location
Most commonly found adjacent to dural sinuses in the following locations:
Transverse (lateral) sinus, left-sided slightly more common than right
Intratentorial
From the posterior cavernous sinus, usually draining to the transverse or sigmoid sinuses
Vertebral artery (posterior meningeal branch)

Causes
It is still unclear whether DAVFs are congenital or acquired. Current evidence supports transverse-sigmoid sinus junction dural malformations are acquired defects, occurring in response to thrombosis and collateral revascularization of a venous sinus. Diagnosis
Cerebral angiography is the diagnostic standard. MRIs are typically normal but can identify venous hypertension as a result of arterial-venous shunting. Classification
Borden Classification
The Borden Classification of dural arteriovenous malformations or fistulas, groups into three types based upon their venous drainage:
Type I: dural arterial supply drains anterograde into venous sinus. Type II: dural arterial supply drains into venous sinus. High pressure in sinus results in both anterograde drainage and retrograde drainage via subarachnoid veins. Type III: dural arterial supply drains retrograde into subarachnoid veins. Type I
Type I dural arteriovenous fistulas are supplied by meningeal arteries and drain into a meningeal vein or dural venous sinus.
In a 2016 report using both mouse models and a limited human clinical trial ROCK2 inhibition with belumosudil targeted both the immunologic and fibrotic components of cGvHD and reversed the symptoms of the disease.In October 2017, belumosudil was granted orphan drug status in the United States for treatment of patients with cGvHD.Efficacy of belumosudil was evaluated in clinical trial NCT03640481, a randomized, open-label, multicenter dose-ranging trial that included 65 patients with chronic GVHD who were treated with belumosudil 200 mg taken orally once daily.On 16 July 2021, the U.S. Food and Drug Administration (FDA) approved belumosudil for adult and pediatric patients 12 years and older with chronic graft-versus-host disease (chronic GVHD) after failure of at least two prior lines of systemic therapy. Research
IPF is a progressive fibrotic disease where the lining of the lungs become thickened and scarred. Increased ROCK activity has been found in the lungs of humans and animals with IPF. Treatment with belumosudil reduced lung fibrosis in a bleomycin mouse model study.Psoriasis is an inflammatory skin condition where patients experiences eruptions and remissions of thickened, erythematous, and scaly patches of skin. Down-regulation of pro-inflammatory responses was observed with KD025 treatment in Phase 2 clinical studies in patients with moderate to severe psoriasis. References
External links
"Belumosudil". Drug Information Portal. U.S. National Library of Medicine.