Surgical management of dural arteriovenous fistulas of the transverse-sigmoid sinus in 42 patients.
A retrospective study was performed to analyse a prospectively collected database from a single surgeon (M.K.M.) of transverse-sigmoid sinus dural arteriovenous fistulas (DAVF) between 1991 and August 2011. During the study period, 144 patients with 160 DAVF were managed. Sixty-five of the DAVF were located in the transverse-sigmoid sinus and 42 were treated with surgery, or embolisation and surgery. All patients who underwent surgery were symptomatic with retrograde cortical venous drainage. The average follow-up period was 18months (range, 2-82months). Total elimination of the DAVF was achieved in all instances, including two patients (5%) who required further surgery after postoperative cerebral angiography showed that some venous drainage had persisted after the first operation. There was no new permanent neurological deficit or mortality attributable to surgery. Our institutional experience shows that in selected patients with transverse-sigmoid sinus DAVF, the involved sinus can be surgically resected with a high success rate and it is as safe as many alternative options. We suggest that this definitive treatment option should be offered to patients, and the outcome should be compared to other treatment modalities.
Australian School of Advanced Medicine, Macquarie University, New South Wales 2109, Australia. Beftekhar@yahoo.com
Behzad
B
Eftekhar
Michael Kerin
MK
Morgan
D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D003392:Cranial Sinuses / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy; D004388:Dura Mater / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012640:Seizures / Q000453:epidemiology / Q000209:etiology; D054064:Transverse Sinuses / Q000601:surgery; D016896:Treatment Outcome