Resection of the transverse sinuses and confluence of sinuses for treatment of multiple dural arteriovenous fistulas. Case report.
Dural arteriovenous fistulas (DAVFs) occurring simultaneously at two or more separate locations are not frequent. In fact, the incidence of multiple DAVFs is 7 to 8% of all DAVFs. Patients harboring multiple DAVFs have a higher incidence of hemorrhage, venous infarction, and neurological deficits due to a greater frequency of leptomeningeal venous drainage. To the authors' knowledge only a few cases of DAVFs involving both transverse sinuses (TSs) have been reported. These patients underwent various combined treatments (transarterial embolization, transvenous obliteration, surgical isolation, resection, and radiosurgery). Treatments performed that do not include resection of the involved sinuses do not always guarantee a cure. The authors present a patient who harbored multiple DAVFs of the TSs, both distally occluded with secondary reflux into the superior sagittal sinus (SSS), the straight sinus, the deep venous system, and the leptomeningeal veins of both hemispheres. An en bloc removal of the portions including the fistulas of the TSs, the confluence of sinuses, and the distal parts of the SSS, and straight sinus allowed for the patient to be cured. The fact is emphasized that despite the progress of endovascular treatment and radiosurgery this kind of DAVF must be surgically treated. The operation may be complex and dangerous.
Fiumara
Ettore
E
Department of Neurosurgery, Villa Sofia Hospital, Palermo, Italy. fgabriele@tin.it
Tumbiolo
Silvana
S
Bellomonte
Maria Luisa
ML
Savatteri
Paolino
P
Finazzo
Francesca
F
La Gattuta
Fabio
F
D000328:Adult; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D003392:Cranial Sinuses / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*