2016 Volume 44 Issue 5 Pages 367-374
The surgical approaches and intravascular interventions for the treatment of dural arteriovenous fistula (dAVF) are important treatment options. Especially surgery should be indicated for non-sinus dAVF, which is often located on the anterior cranial base or the posterior cranial fossa. In this study, cases with dAVF treated with the surgical approach were retrospectively reviewed to etiologically evaluate the efficacy of surgery.
Materials and Methods: Twenty-eight patients diagnosed as having dAVF were treated in the Juntendo University Shizuoka Hospital between 2009 and 2014. Of all the patients, 9 (32.1%) were treated with direct surgery to disconnect the abnormal vessels from the dAVF to the cortical veins. Four patients were asymptomatic, and the remaining 5 were symptomatically diagnosed. The 4 cases were onset by intracranial hemorrhage, and one case had an ischemic event.
Results: All the cases treated with surgery were classified as Borden type III dAVF, in which abnormal vessels were drained into the cortical veins through the subarachnoid venous system. In this type, socalled the non-sinus type, obliteration by intravascular treatment might be difficult because of the absence of the sinus targeted in the transvenous embolization. In this study, no morbidity or mortality associated with the surgical procedures occurred in any of the patients. Intraoperative angiography with indocyanine green was definitely useful and is an important modality.
Conclusions: Direct surgery combined with skull base techniques and intraoperative angiography is safe and effective for Borden type III dAVF.
