抄録
Dural arteriovenous fistulas (DAVFs) of the anterior cranial fossa are rare anomalies that invariably present with cortical venous reflux because of the absence of dural sinus in the affected region. Previous reports have identified intracranial hemorrhage as the major symptom and have confirmed that good surgical outcome can be obtained by open surgery. Recently, however, the widespread use of MRI has led to an increase in the incidental detection of asymptomatic DAVFs of the anterior cranial fossa. Treatments for these asymptomatic lesions are now a focus of discussion.
We treated four patients with anterior cranial fossa DAVFs between 2005 and 2010. One of the patients presented intracranial hemorrhage and the other three were asymptomatic.
The three patients with intracranial hemorrhage underwent open surgery and the other asymptomatic patient underwent endovascular surgery. The latter patient initially underwent transarterial embolization with only partial success. The patient was completely cured by the transvenous approach with platinum coils. All four patients were successfully treated without any adverse events.
Previous papers reported similarly high annual intracranial hemorrhage rates from DAVFs with cortical venous reflux. This suggests that surgical treatment for asymptomatic patients with anterior cranial fossa DAVFs should be considered. Direct surgery has been the treatment of choice for this disease so far. For asymptomatic patients, however, endovascular treatment with transvenous embolization may serve as an effective alternative to open surgery.
