Combining endovascular and neurosurgical treatments of high-risk dural arteriovenous fistulas in the lateral sinus and the confluence of the sinuses

Abstract

<jats:p>The authors describe their experience in treating dural arteriovenous fistulas (DAVFs) in the lateral sinus and the confluence of sinuses in 17 patients who presented with signs and symptoms related to intracranial hemorrhage, infarction, and diffuse brain swelling. Angiographic examination revealed three different types of DAVFs in these high-risk patients: 1) extremely high flow DAVF not associated with sinus occlusion or leptomeningeal retrograde venous drainage (LRVD); 2) localized DAVF with exclusive LRVD and without sinus occlusion; and 3) diffuse DAVF with sinus occlusion and LRVD. Because of the complex nature of these lesions, the authors adopted a staged protocol in which they combined endovascular and surgical treatments.</jats:p> <jats:p>The authors believe that by close collaboration between endovascular therapists and vascular neurosurgeons, high-risk DAVFs in the lateral sinus and the confluence of sinuses can be successfully treated without treatment-related morbidity and mortality.</jats:p>

Intracranial arterial and arteriovenous malformations presenting with infarction. Lausanne Stroke Registry study*

“…A large number of CDAVFs can be treated by endovascular embolization (Hirono et al, 1993;Zeidman et al, 1995;Datta et al, 1998;Biondi et al, 1999;Goto et al, 1999;Pollock et al, 1999); other therapeutic methods are microsurgery (Zeidman et al, 1995;Endo et al, 1998;Goto et al, 1999;Greenough et al, 1999), radiosurgery (Datta et al, 1998;Pollock et al, 1999), or the combination of several methods (Zeidman et al, 1995;Datta et al, 1998;Goto et al, 1999;Pollock et al, 1999). The choice of treatment method depends on the type of fistula (Olteanu-Nerbe et al, 1997;Eckert and Zeumer, 1998;Mathis and Dion, 1998).…”

Persistent Primitive Trigeminal Artery That Mimics Persistent Primitive Otic Artery on Cerebral Angiography

“…The reason for the frequent coexistence of intracranial aneurysms with PTA has been explained by the presence of structural defects in the walls of the cerebral arteries. Also, other associated vascular anomalies, such as VB insufficiency, arteriovenous anomalies, arteriovenous fistulas, and Moyamoya disease have been reported 3)7)8)11). Our case of SAH due to a ruptured aneurysm associated with a lower-lying PPTA and concomitant multiple aneurysms is rare.…”

Combined surgical and endovascular treatment of a posterior fossa dural arteriovenous fistula

“…6,7,8 The treatment of our patient was based on a description of similar management by Goto et al 9 In patients who fail endovascular access initially, they recommend a limited open surgical approach to enable direct access to the diseased segment of the venous sinus, followed by packing of the diseased segment under intraoperative angiography. We achieved complete exclusion of the DVAF in our patient using this method.…”