Abstract
Thirteen dural arteriovenous malformations (AVMs) involving the lateral and sigmoid sinuses were treated with a variety of treatment modalities. Three patients underwent surgical isolation of affected sinuses by clipping and ligation of all feeding arteries at the dura mater and tentorium; Two of these patients had complete obliteration of their fistulas and 1 patient, with advanced severe neurological deficits, died of general malaise 6 months after surgery. Three patients, who were treated by surgical removal of the affected sinus, had complete cure immediately after surgery; 1 of these 3 patients was treated by transarterial embolization with polyvinyl alcohol before surgery. Her symptoms improved trasiently but recurred in several days. Three patients were treated by palliative surgery such as the ablation of periosteum from occipital bone, ligation of external carotid artery and/or its branches and venticulo-peritoneal shunt. Their symptoms improved transiently but aggravated at the follow-up periods. Three patients with asymptomatic dural AVM had conservative treatment.
From our experiences, the most effective treatment is thought to be complete removal of the affected sinus in the early stage.
Histopathological profiles of this disease were studied in serial sections of resected lesions from the above 3 patients. The essential lesion was confirmed histologically to be dural arteriovenous fistulas within the wall of the venous sinuses.
