Microsurgical treatment of intracranial dural arteriovenous fistulas. Case series and review of the literature
Objective ‒ to evaluate peculiarities and results of microsurgical treatment of intracranial dural arteriovenous fistulas (DAVF).
Materials and methods. A retrospective analysis of microsurgical treatment of 7 patients with DAVF (4 (57. 1%) women and 3 (42.9 %) men, average age ‒ 43.4 years), who were hospitalized and surgically treated at the SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» from 2016 to 2020, was made. DAVF was drained into the superior sugittal sinus in 4 (57.1 %) patients, transverse and sigmoid sinuses in 2 (28.6 %) cases, in the middle cranial fossa in 1 (14.3 %). According to the Cognard classification there were 3 (42.9 %) DAVFs belong to type IIb, 2 (28.6 %) ‒ to type IIa + b, 1 (14.3 %) DAVF ‒ to type II, 1 (14.3 %) DAVF ‒ to type IV.
Results. In 3 (42.9 %) patients were primarily treated with endovascular method. Follow up studies revealed a recurrence of the disease, and microsurgical disconnection was performed. In 4 (57.1 %) cases, endovascular access to superficial DAVF was risky due to anatomical features, and microsurgery was preferred. In all patients, surgical treatment aimed the disconnecting of the shunt. In 1 (14.3 %) case of DAVF the transverse sinus was ligated. In all cases angiographic confirmation of the DAVFs exclusion was performed. In the postoperative period, there was no evidence of an increasing of clinical symptoms. All patients with pulsatile tinnitus and headache noted their regression after surgery.
Conclusions. Considering the efficacy of modern endovascular techniques, microsurgery of DAVF has been indicated in cases where endovascular embolization has proven to be no-n-efficient or technically impossible. Among surgical methods of DAVF treatment, there are disconnection of the meningeal arteries directly at the site of the fistula, resection of the abnormal dura mater with feeding vessels, ligation and intersections of the injured venous sinus, skeletonization of the sinus with the feeding dural vessels. Treatment should be performed in all cases of DAVF with cortical venous drainage and progressive symptoms of the disease. The choice of optimal treatment should be made in a multidisciplinary manner, and all possible methods should be taken into consideration.
Tsai L, Liu H, Jeng J. Diagnosis and management of intracranial dural arteriovenous fistulas. Expert Review of Neurotherapeutics. 2016;16(3):307-18. doi: 10.1586/14737175.2016
Ghobrial G, Marchan E, Nair A et al. Dural arteriovenous fistulas: A review of the literature and a presentation of a single institution’s experience. World Neurosurgery. 2013;80(1-2):94-102. PMID: 22381858 DOI: 10.1016/j.wneu.2012.01.053
Elhammady M, Ambekar S, Heros R. Epidemio-logy, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas. Handbook of Clinical Neurology; 2017. P. 99-105. PMID: 28552162 DOI: 10.1016/B978-0-444-63640-9.00009-6
Reynolds M, Lanzino G, Zipfel G. Intracranial dural arteriovenous fistulas. Stroke. 2017;48(5):1424-31. doi: 10.1161/STROKEAHA.116.012784.
Zipfel G, Shah M, Refai D. et al. Cranial dural arteriovenous fistulas: modification of angiographic classification scales based on new natural history data. Neurosurgical Focus. 2009;26(5):E14. doi: 10.3171/2009.2.
Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, Piepgras DG, Forbes GS, Thielen K, Nichols D, O’Fallon WM, Peacock J, Jaeger L, Kassell NF, Kongable-Beckman GL, Torner JC, International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet. 2003 Jul 12;362(9378):103-10. PMID: 12867109 DOI: 10.1016/s0140-6736(03)13860-3
Ondra S, Troupp H, George E, Schwab K. The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment. Journal of Neurosurgery. 1990;73(3):387-91. PMID: 2384776 DOI: 10.3171/jns.1990.73.3.0387
Kakarla U, Deshmukh V, Zabramski J et al. Surgical treatment of high-risk intracranial dural arteriovenous fistulae. Neurosurgery. 2007;61(3):447-59. PMID: 17881955 DOI: 10.1227/01.NEU.0000290889.62201.7F
Collice M, D’Aliberti G, Arena O et al. Surgical treatment of intracranial dural arteriovenous fistulae: role of venous drainage. Neurosurgery. 2000;47(1):56-67. PMID: 10917347 DOI: 10.1097/00006123-200007000-00012
Youssef P, Schuette A, Cawley C, Barrow D. Advances in surgical approaches to dural fistulas. Neurosurgery. 2014;74(suppl.1):S32-S41. PMID: 24402490 DOI: 10.1227/NEU.0000000000000228
Oh J, Yoon S, Oh H et al. Endovascular treatment of dural arteriovenous fistulas: single center experience. Journal of Korean Neurosurgical Society. 2016;59(1):17-25. PMID: 26885282 PMCID: PMC4754583 DOI: 10.3340/jkns.2016.59.1.17
Oh S, Choi J, Kim B et al. Treatment outcomes according to various treatment modalities for intracranial dural arteriovenous fistulas in the onyx era: A 10-year single-center experience. World Neurosurgery. 2019;126:e825-e834. PMID: 30862595 DOI: 10.1016/j.wneu.2019.02.173
Abstract views: 27 PDF Downloads: 10