The role of surgery for high-grade intracranial dural arteriovenous fistulas: importance of obliteration of venous outflow.

Abstract:

OBJECT:Surgical intervention may be required if endovascular embolization is insufficient to completely obliterate intracranial dural arteriovenous fistulas (DAVFs). The authors report their 14-year experience with 23 patients harboring diverse intracranial DAVFs that required surgical intervention. METHODS:Between 1993 and 2007, 23 patients underwent surgery for intracranial DAVFs. The following types of DAVFs were treated: superior petrosal sinus (in 10 patients); parietooccipital (in 3); confluence of sinuses and ethmoidal (in 2 each); and tentorial, falcine, occipital, transverse-sigmoid, superior sagittal, and cavernous sinuses (in 1 patient each). In all cases, the authors' goal was to obliterate the DAVF venous outflow by direct surgical interruption of the leptomeningeal venous drainage. Transarterial embolization was used primarily as an adjunct to decrease flow to the DAVF prior to definitive treatment. RESULTS:Complete angiographic obliteration of the DAVF was achieved in all cases. There were no complications of venous hypertension, venous infarction, or perioperative death. There were no recurrences and no further clinical events (new hemorrhages or focal neurological deficits) after a mean follow-up of 45 months. CONCLUSIONS:The authors' experience emphasizes the importance of occluding venous outflow to obliterate intracranial DAVFs. Those that drain purely through leptomeningeal veins can be safely obliterated by surgically clipping the arterialized draining vein as it exits the dura. Radical excision of the fistula is not necessary.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Liu JK,Dogan A,Ellegala DB,Carlson J,Nesbit GM,Barnwell SL,Delashaw JB

doi

10.3171/2008.9.JNS08733

subject

Has Abstract

pub_date

2009-05-01 00:00:00

pages

913-20

issue

5

eissn

0022-3085

issn

1933-0693

pii

10.3171/2008.9.JNS08733

journal_volume

110

pub_type

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