The treatment of complex dural arteriovenous fistulae through cranial base techniques.
BACKGROUND
The endovascular modality of treatment is the preferred treatment modality for DAVF. In some circumstances, successful obliteration may not be possible by endovascular means, and such cases may require a direct surgical treatment. The authors report on their experience with the use of cranial base approaches in the treatment of deep and complex DAVF.


METHODS
Nine patients were treated between 1992 and 2003. There were six females and three males. Four patients presented with intracerebral hemorrhage, two with progressive myelopathy, two with tinnitus, and one with incapacitating chronic seizures. Four DAVF were tentorial, two transverse sigmoid, one craniocervical, one straight sinus, and one sphenoparietal. Endovascular embolization was attempted and unsuccessful in four cases, and was successful only as an adjunct to surgery in four others. All patients required the use of cranial base approaches to disconnect the fistula or resect the nidus.


RESULTS
Complete obliteration of the fistula was possible in all cases. Six-month follow-up results were obtained on seven patients where there was no evidence of recurrence. One postoperative temporal-lobe hematoma required surgical evacuation. One patient died two years postoperatively from an unrelated cause.


CONCLUSIONS
This retrospective study demonstrates that complex DAVF can be successfully treated with the assistance of cranial base techniques.
Central Illinois Neuroscience Foundation, Bloomington, Illinois 61701, USA. jmbaboukis@yahoo.com.
Keith A
KA
Kattner
Toni C
TC
Roth
Emilio M
EM
Nardone
Steven L
SL
Giannotta
D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000601:surgery*; D002533:Cerebral Angiography; D003399:Craniotomy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D016634:Radiosurgery; D012189:Retrospective Studies; D019291:Skull Base / Q000601:surgery*; D016896:Treatment Outcome