Abstract
In this paper discuss the surgical treatment of dural arteriovenous fistulas around the superior sagittal and transverse sigmoid sinuses. Although transarterial or transvenous embolization are primarily used in the treatment of dural arteriovenous fistulas, it is very difficult to completely obliterate the fistulas. The final goal of treatment of this lesion should be complete occlusion of the lesion. Otherwise, the possibility of recurrence and the risk of bleeding from the lesion will continue. We are considering that surgical resection of the lesion with the affected sinus is the best way to accomplish the final goal of treatment, that is the complete obliteration of the lesion. To decrease the risk of intraoperative bleeding, the arterial supply into the lesion was embolized before the surgery. In the practical surgery, the bone flap was constructed piecemeal and meticulous hemostasis was carried out, because bleeding from the epidural space was usually remarkable. Using B-mode echo imaging, the affected sinus was distinguished from the unaffected sinus. The direction of the draining cortical venous blood flow was detected with a micro-Doppler flow meter, and then the area of the dura mater and dural sinus involved with the arteriovenous fistula were confirmed and removed totally. Postoperatively, late intracerebral hemorrhage or edema may be induced by venous infarction or hyperperfusion pressure breakthrough secondary to the shut down of the draining cortical venous blood flow.
