**7. Conclusion**

Much has been learned in recent years about the pathoanatomy, pathophysiology, natural history, and therapeutic options for DAVFs. A better understanding of these lesions has allowed more prompt and precise diagnosis, in addition, a realistic assessment of features predisposing to aggressive clinical course. Clinical symptoms other than hemorrhage and progressive neurological deficits rarely warrants aggressive treatment of a DAVF, unless the lesion is particularly accessible or is associated with features predisposing to subsequent aggressive clinical behavior. Patient reassurance, symptomatic treatment, or palliative therapy is frequently sufficient. In DAVFs with features predisposing to an aggressive clinical course, a more definitive treatment strategy should be adopted. It is obvious that the myriad of clinical manifestations of DAVFs and the wide spectrum of possible angiographic and pathophysiologic scenarios call for highly individualized management strategies. The diagnostic investigation should be thorough to identify DAVFs with features predisposing to aggressive clinical behavior such as retrograde and leptomeningeal CVD, associated aneurysms, or venous ectasia.
