Borden classification of dural arteriovenous fistulas

The Borden classification of dural arteriovenous fistulas (DAVF) groups these lesions into three types based upon the site of venous drainage and the presence or absence of cortical venous drainage. It was first proposed in 1995 1. At the time of writing (July 2016), it is probably less popular than the more complicated Cognard classification system

The Borden classification divides dural arteriovenous fistulas into 3 types according to the site of location and presence or absence of cortical venous drainage. Unlike the Cognard classification system, it does not assess the direction of flow or presence of venous ectasia.

  • type I
    • drainage into meningeal veins, spinal epidural veins or into a dural venous sinus
    • normal anterograde flow in both the draining veins and other veins draining into the system
    • equivalent to Cognard type I and IIa, with a favourable natural history 2,4
  • type II
    • drainage into meningeal veins, spinal epidural veins or into a dural venous sinus 
    • retrograde flow into the normal subarachnoid veins
    • equivalent to Cognard type IIb and IIa+b
  • type III
    • direct drainage into subarachnoid veins or into an isolated segment of the venous sinus (which results from a thrombosis on either side of the dural sinus segment)
    • equivalent to Cognard type III, IV and V

According to this classification, these lesions are further subclassified in type a (single-hole) or type b (multiple-hole) fistulas.

Clinical course depends on type as well as location. Type I dural arteriovenous fistulas usually have a benign clinical behaviour, presenting incidentally or with symptoms of increased dural venous drainage (i.e. pulsatile tinnitus, exophthalmos) provided they are within the intracranial compartment. Aggressive behaviour was only found in 2% of such cases 3

Spinal type I dural AVFs can result in myelopathy due to venous hypertension (see spinal DAVF).

Those with cortical venous drainage (type II and III) have a more aggressive natural history, with increased risk of haemorrhage or of a non-hemorrhagic neurological deficit. Type II was found to have an aggressive behaviour in 39% and type III in 79% of cases 2,3

In general, the Cognard classification does have greater ability to separate patients prognostically 3.  

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rID: 21669
Synonyms or Alternate Spellings:
  • Borden classification of dAVF
  • Borden classification of dAVF's

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