Intracranial dural arteriovenous fistula successfully treated by combined open-endovascular procedure

Transarterial embolization with ONYX for treatment of intracranial non-cavernous dural arteriovenous fistula with or without cortical venous reflux

“…However, in two patients, direct surgical access to the main feeding artery was requested because we assessed the level of distal microcatheterization inadequate for successful embolization. In the first patient, the MMA was opened via neurosurgical trepanation to allow direct cannulation and catheterization 27. In the other patient, the OA was transected neurosurgically to perform direct cannulation and transosseus microcatheterization of dural feeders.…”

“…We were more restrictive with reflux in the meningeal arteries and preferred to look for an additional feeder. Moreover, we cooperated with our neurosurgeons to get direct access to the main feeder when distal microcatheterization was impeded by vessel tortuosity 27. Technical complications involved glued catheters and ruptured microguidewires.…”

Combined surgical and endovascular treatment of complex cerebrovascular diseases in the hybrid operating room

“…However, complete occlusion is not always guaranteed and sometimes catheter gluing is one of the complications of aggressive Onyx injection. Hallaert et al reported on the transarterial combined surgical and endovascular treatment of dAVF using Onyx 15. When the patient has a complex high-flow AV shunt, a scheduled transarterial feeder occlusion followed by surgical occlusion of the draining vein may be the best treatment option.…”

Hybrid surgery for dural arteriovenous fistula in the neurosurgical hybrid operating suite

“…The use of combined surgical and endovascular treatment of dural AVFs is hardly a new concept. [5][6][7][8] However, this combination has rarely been reported due to the rarity of complex dural AVFs. Furthermore, most previous combined surgeries were performed in separate sessions due to the lack of facilities.…”