Standard and Guidelines: Intracranial Dural Arteriovenous Shunts
Bibliographic record
Abstract
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: Table 1 ACC/AHA Classification of Recommendations and Level of Evidence (COR/LOE) View this table: Table 2 Definition of classes and levels of evidence used in AHA/ASA recommendations Given 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. …
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".