[Surgical interruption of draining vein or dural sinus: treatment for petrotentorial dural arteriovenous malformation].
The authors report three cases with petrotentorial dural arteriovenous malformation who underwent surgical interruption of the draining vein or dural sinus. They discuss the rationale and feasibility of this surgical procedure. Case 1 (70-year-old man) presented with trigeminal neuralgia and cerebellar ataxia caused by subarachnoid and cerebellar hemorrhage. Case 2 (68-year-old man) with trigeminal neuralgia due to venous mass effect. Case 3 (48-year-old man) with dementia caused by venous ischemia in the bilateral thalami. Cases 1 and 2 underwent lateral suboccipital craniotomy followed by infratentorial supracerebellar approach, and the draining vein was interrupted by aneurysmal clip under the cerebellar tentorium. Case 3 underwent surgical occlusion of the straight sinus by occipital transfalcine transtentorial approach after transarterial embolization had failed. Intraoperative digital subtraction angiography revealed the disappearance of dural AVMs in all three cases. The clinical symptoms disappeared postoperatively, and follow-up 6-vessel-angiography 2, 20, 11 months later, respectively, revealed no recurrence of dural AVMs. It has recently been proposed that many cranial dural AVMs with leptomeningeal venous drainage require only interruption of the draining vein as it enters the subarachnoid space for successful, lasting elimination. The striking clinical and radiological improvement in these cases emphasizes the pivotal role of surgical occlusion of the draining vein for petrotentorial dural AVMs which are not amenable to cure by endovascular procedures.
Ito
M
M
Department of Neurosurgery, East Tokyo Metropolitan Hospital.
Sonokawa
T
T
Mishina
H
H
Iizuka
Y
Y
Sato
K
K
D000368:Aged; D015901:Angiography, Digital Subtraction; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014680:Veins