Microsurgical Interhemispheric Approach to Dural Arteriovenous Fistulas of the Floor of the Anterior Cranial Fossa

Abstract

Six patients with a dural arteriovenous fistula (DAVF) of the floor of the anterior cranial fossa underwent microsurgical treatment. Two of them were operated using a conventional frontobasal approach, and four using an interhemispheric approach. The interhemispheric approach offers the advantages of sparing the frontal sinus, minimizing frontal lobe retraction, and providing a visual angle perpendicular to the floor of the anterior fossa and an excellent view of the fistula located on the cribriform plate at the level of the foramen caecum. Using the interhemispheric route, the malformation was occluded in all the cases by dividing the vascular connection between the dura of the cribriform plate and the intradural draining vein. There were no complications related to the surgical procedure. This route avoids some disadvantages of the more frequently reported frontobasal approach. It is therefore a recommendable alternative for the management of frontal DAVFs.

Dural Arteriovenous Fistula in the Anterior Cranial Fossa -Four Case Reports-

“…1,4,5,7,8,[13][14][15][16] Direct drainage into the subfrontal cortical veins causes intracranial venous hypertension associated with a high incidence of intracranial hemorrhage and other clinical symptoms such as headache, seizure, and visual loss. 4) Evaluation of the intracranial venous hypertension is essential for deciding on the method of treatment for asymptomatic or nonruptured DAVF.…”

“…1,4,5,8,[13][14][15] Transarterial embolization is possible but not common because of the difficulty in catheterizing small vessels and the high risk of visual compromise due to occlusion of the retinal branches. 1,5,7,8,13) Transvenous embolization using coils has potential, as this technique supports the navigation of a microcatheter through the frontal bridging vein tortuosities, enabling the detection of the exact location of the fistula.…”

Moderne Schädelbasischirurgie aus Sicht des Neurochirurgen

“…Der Einsatz des Operations-(Op.-)Mikroskops, welches sich bei Operationen an der Schädelba-sis in den 1980er-Jahren durchgesetzt hat, war ein Meilenstein und erlaubte einerseits die radikale Entfernung von Tumoren und ermöglichte andererseits durch die bessere Visualisierung auch eine Reduktion der chirurgisch bedingten Morbidität und Mortalität. Durch die mikrochirurgischen Techniken war dann die Behandlung von komplexen Gefäßmiss-bildungen, insbesondere Aneurysmen und Angiomen, im Bereich der Schädel-basis besser durchführbar [13]. Auch in der Tumorchirurgie bewährten sich die mikrochirurgischen Techniken, was sich insbesondere bei der Entfernung gutartiger Tumoren wie Akustikusneurinome oder Meningeome im Bereich des Keilbeinflügels und des Clivus zeigte.…”

Arteriovenous Fistula Arising From the Persistent Primitive Olfactory Artery With Dual Supply From the Bilateral Anterior Ethmoidal Arteries -Case Report-

“…2,3) Surgical obliteration of the abnormal shunt is the preferred therapeutic option, but recently endovascular management or radiosurgery and multidisciplinary approaches have also become potential therapeutic approaches. 1,[4][5][6]9,11) The persistent primitive olfactory artery (PPOA) is a rare remnant of the fetal arteries that usually dwindles but infrequently persists as a small branch accompanying the olfactory nerve into the nasal cavity, and a larger derivative extends laterally to enter the mesial part of the anterior perforated substance as the recurrent artery of Heubner at 44 days ovulation age. The PPOA remains only as part of the recurrent artery of Heubner in normal vascular developments.…”