Complex dural arteriovenous fistulas

Results of combined endovascular and neurosurgical treatment in 16 patients

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✓ Of the 88 patients evaluated for symptomatic dural arteriovenous (AV) fistula over the past 8 years, 16 had large or complicated lesions that could not be treated with standard transvascular approaches or in which such treatment had been unsuccessful. Eleven fistulas were located in the transverse sinus, two in the cavernous sinus, two in the straight sinus, and one in the falx-tentorial region near the vein of Galen. The patients were treated with a combination of endovascular and neurosurgical techniques. Fourteen patients underwent preoperative transarterial embolization; this procedure closed the fistula in one patient. In the remaining 15 patients, surgery was performed to provide access to the fistula for embolization from either the venous or the arterial side, or for excision of the fistula. Transvenous embolization completely obliterated the fistula in seven of nine patients; the fistulas were embolized incompletely through the feeding arteries in two patients; and complete surgical resection of the lesion was accomplished in four patients. Complications related to venous occlusion occurred in two patients and one patient suffered communicating hydrocephalus that was effectively treated by shunting. There were no deaths. The results suggest that combined endovascular and neurosurgical techniques are a safe and effective means for the treatment of selected complex dural AV fistulas.

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Address reprint requests to: Stanley L. Barnwell, M.D., Ph.D., c/o The Editorial Office, 1360 Ninth Avenue, Suite 210, San Francisco, California 94122.

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References
  • 1.

    Grisoli FVincentelli FFuchs Set al: Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space. Report of four cases. J Neurosurg 60:105910661984Grisoli F Vincentelli F Fuchs S et al: Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space. Report of four cases. J Neurosurg 60:1059–1066 1984

    • Search Google Scholar
    • Export Citation
  • 2.

    Halbach VVHigashida RTHieshima GBet al: Dural fistulas involving the cavernous sinus: results of treatment in 30 patients. Radiology 163:4374421987Halbach VV Higashida RT Hieshima GB et al: Dural fistulas involving the cavernous sinus: results of treatment in 30 patients. Radiology 163:437–442 1987

    • Search Google Scholar
    • Export Citation
  • 3.

    Halbach VVHigashida RTHieshima GBet al: Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients. Radiology 163:4434471987Halbach VV Higashida RT Hieshima GB et al: Dural fistulas involving the transverse and sigmoid sinuses: results of treatment in 28 patients. Radiology 163:443–447 1987

    • Search Google Scholar
    • Export Citation
  • 4.

    Lasjaunias PChiu MTer Brugge Ket al: Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 64:7247301986Lasjaunias P Chiu M Ter Brugge K et al: Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 64:724–730 1986

    • Search Google Scholar
    • Export Citation
  • 5.

    Malik GMPearce JEAusman JLet al: Dural arteriovenous malformations and intracranial hemorrhage. Neurosurgery 15:3323391984Malik GM Pearce JE Ausman JL et al: Dural arteriovenous malformations and intracranial hemorrhage. Neurosurgery 15:332–339 1984

    • Search Google Scholar
    • Export Citation
  • 6.

    Mullan S: Treatment of carotid-cavernous fistulas by cavernous sinus occlusion. J Neurosurg 50:1311441979Mullan S: Treatment of carotid-cavernous fistulas by cavernous sinus occlusion. J Neurosurg 50:131–144 1979

    • Search Google Scholar
    • Export Citation
  • 7.

    Newton THCronqvist S: Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93:107110781969Newton TH Cronqvist S: Involvement of dural arteries in intracranial arteriovenous malformations. Radiology 93:1071–1078 1969

    • Search Google Scholar
    • Export Citation
  • 8.

    Obrador SSoto MSilvela J: Clinical syndromes of arteriovenous malformations of the transverse-sigmoid sinus. J Neurol Neurosurg Psychiatry 38:4364511975Obrador S Soto M Silvela J: Clinical syndromes of arteriovenous malformations of the transverse-sigmoid sinus. J Neurol Neurosurg Psychiatry 38:436–451 1975

    • Search Google Scholar
    • Export Citation
  • 9.

    Quisling RGMickle JPBallinger W: Small particle polyvinyl alcohol embolization of cranial lesions with minimal arteriolar-capillary barriers. Surg Neurol 25:2432521986Quisling RG Mickle JP Ballinger W: Small particle polyvinyl alcohol embolization of cranial lesions with minimal arteriolar-capillary barriers. Surg Neurol 25:243–252 1986

    • Search Google Scholar
    • Export Citation
  • 10.

    Russel EJBerenstein A: Neurologic applications of interventional radiology. Neurol Clin 2:8739021984Russel EJ Berenstein A: Neurologic applications of interventional radiology. Neurol Clin 2:873–902 1984

    • Search Google Scholar
    • Export Citation
  • 11.

    Sundt TM JrPiepgras DG: The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg 59:32391983Sundt TM Jr Piepgras DG: The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses. J Neurosurg 59:32–39 1983

    • Search Google Scholar
    • Export Citation
  • 12.

    Suzuki JKomatsu S: New embolization method using estrogen for dural arteriovenous malformation and meningioma. Surg Neurol 16:4384421981Suzuki J Komatsu S: New embolization method using estrogen for dural arteriovenous malformation and meningioma. Surg Neurol 16:438–442 1981

    • Search Google Scholar
    • Export Citation
  • 13.

    Viñuela FFox AJPelz DMet al: Unusual clinical manifestations of dural arteriovenous malformations. J Neurosurg 64:5545581986Viñuela F Fox AJ Pelz DM et al: Unusual clinical manifestations of dural arteriovenous malformations. J Neurosurg 64:554–558 1986

    • Search Google Scholar
    • Export Citation
  • 14.

    Wilkins RH: Natural history of intracranial vascular malformations: a review. Neurosurgery 16:4214301985Wilkins RH: Natural history of intracranial vascular malformations: a review. Neurosurgery 16:421–430 1985

    • Search Google Scholar
    • Export Citation
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