Document Detail

The role of surgery for high-grade intracranial dural arteriovenous fistulas: importance of obliteration of venous outflow.
MedLine Citation:
PMID:  19199500     Owner:  NLM     Status:  MEDLINE    
OBJECT: Surgical intervention may be required if endovascular embolization is insufficient to completely obliterate intracranial dural arteriovenous fistulas (DAVFs). The authors report their 14-year experience with 23 patients harboring diverse intracranial DAVFs that required surgical intervention. METHODS: Between 1993 and 2007, 23 patients underwent surgery for intracranial DAVFs. The following types of DAVFs were treated: superior petrosal sinus (in 10 patients); parietooccipital (in 3); confluence of sinuses and ethmoidal (in 2 each); and tentorial, falcine, occipital, transverse-sigmoid, superior sagittal, and cavernous sinuses (in 1 patient each). In all cases, the authors' goal was to obliterate the DAVF venous outflow by direct surgical interruption of the leptomeningeal venous drainage. Transarterial embolization was used primarily as an adjunct to decrease flow to the DAVF prior to definitive treatment. RESULTS: Complete angiographic obliteration of the DAVF was achieved in all cases. There were no complications of venous hypertension, venous infarction, or perioperative death. There were no recurrences and no further clinical events (new hemorrhages or focal neurological deficits) after a mean follow-up of 45 months. CONCLUSIONS: The authors' experience emphasizes the importance of occluding venous outflow to obliterate intracranial DAVFs. Those that drain purely through leptomeningeal veins can be safely obliterated by surgically clipping the arterialized draining vein as it exits the dura. Radical excision of the fistula is not necessary.
James K Liu; Aclan Dogan; Dilantha B Ellegala; Jonathan Carlson; Gary M Nesbit; Stanley L Barnwell; Johnny B Delashaw
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of neurosurgery     Volume:  110     ISSN:  0022-3085     ISO Abbreviation:  J. Neurosurg.     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-19     Completed Date:  2009-06-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0253357     Medline TA:  J Neurosurg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  913-20     Citation Subset:  AIM; IM    
Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon, USA.
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MeSH Terms
Central Nervous System Vascular Malformations / radiography
Cerebral Angiography
Cerebral Veins / surgery*
Dura Mater / blood supply*
Embolization, Therapeutic
Intracranial Arteriovenous Malformations / radiography,  surgery*
Middle Aged
Neurosurgical Procedures / methods

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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