title: Combined surgical approach with intraoperative endovascular embolization for inaccessible dural arteriovenous fistulas.
abstract: BACKGROUND
  We describe an alternative treatment modality for inaccessible intracranial DAVFs caused by local thrombosis or tortuous feeder vessels. Special consideration is given to the efficacy of intraoperative endovascular embolization and to the use of various operative routes depending on the location of the lesions.
  
  
  METHODS
  Between August 1999 and January 2006, 7 of 65 patients were diagnosed with DAVFs with the limitation of endovascular access. Thus, we adopted a combined surgical approach with intraoperative endovascular embolization. We reviewed and analyzed the patients' medical records and their outcomes.
  
  
  RESULTS
  Depending on tumor location, a surgical approach combined with simultaneous intraoperative endovascular embolization was successfully performed via the SOV, the TS-SS junction, and the SSS. No complication related to the treatment was reported, and, subsequently, all the patients recovered completely.
  
  
  CONCLUSIONS
  A combined surgical approach with simultaneous intraoperative embolization is an effective and safe treatment for DAVFs that are of limited angiographic access.
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul 135-710, Korea.
authors.forename: Doo-Sik
authors.initials: DS
authors.lastname: Kong
authors.forename: Ki-Hun
authors.initials: KH
authors.lastname: Kwon
authors.forename: Jong Soo
authors.initials: JS
authors.lastname: Kim
authors.forename: Seung-Chyul
authors.initials: SC
authors.lastname: Hong
authors.forename: Pyoung
authors.initials: P
authors.lastname: Jeon
mesh_terms: D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D003392:Cranial Sinuses; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D016896:Treatment Outcome