Cranial Base Approaches for the Surgical Treatment of Aggressive Posterior Fossa Dural Arteriovenous Fistulae with Leptomeningeal Drainage: Report of Four Technical Cases

Abstract

Recent advances in cranial base techniques have allowed the successful obliteration of aggressive posterior fossa DAVFs with acceptable morbidity. The use of these techniques should be considered in selected patients who cannot be treated with endovascular approaches.

Dural arteriovenous fistulas draining into the petrosal vein or bridging vein of the medulla: possible homologs of spinal dural arteriovenous fistulas

“…We excluded DAVFs located in remote regions that drained into posterior fossa veins secondary to thrombosis of their "natural" outlets, in particular cavernous sinus or transversesigmoid lesions with venous occlusions. In the previously published literature, we found 30 cases of petrosal vein DAVFs 4,5,[7][8][9]13,16,21,30,33,[36][37][38]41,45,48,52,55,56,59,60 and 35 cases of medulla bridging vein DAVFs, 1,11,14,[17][18][19][20][22][23][24][25]31,32,35,39,40,43,46,50,51,53,58,61 all of which were well described with clinical and angiographic information. These previously reported cases were analyzed together, with special attention to their clinical characteristics.…”

Treatment of Intracranial Dural Arteriovenous Fistulas: Current Strategies Based on Location and Hemodynamics, and Alternative Techniques of Transcatheter Embolization

“…† Numbers in parentheses indicate percentages of cases. (15,18,21,29,30,(53)(54)(55)(56)(57)(58). The efficacy, potential risk, and difficulty of these options are described in Table 7.…”

Intraoperative Angiography for Cranial Dural Arteriovenous Fistula

“…26,27,34,35 Various surgical techniques, including packing of the sinus, skeletonization of the sinus, disconnection of the feeders, as well as disconnection of the leptomeningeal venous drainage, have been described. [9][10][11]13,[36][37][38][39][40] Although it has been mentioned in many surgical series that routine IA for DAVF is recommended and is useful, there is no report specifically analyzing the role of IA in surgery for DAVF, to our knowledge.…”

“…[3][4][5][6][7][8] However, there is a small subset of patients who have DAVFs with anatomic features requiring surgical treatment. [9][10][11] Because DAVFs do not have a compact nidus and are surgically treated by various means, including packing of the sinus, disconnection of the leptomeningeal veins, and disconnection of the dural feeders from the sinus, [12][13][14] it is important to document complete resection of the DAVF and absence of any early draining veins intraoperatively to avoid the risk of hemorrhage postoperatively and to avoid a second surgery for the patient.…”