title: Combined surgical and endovascular treatment of high-risk intracranial dural arteriovenous fistulas.
abstract: We evaluated the efficacy of combined surgical and endovascular treatment of high-risk dural arteriovenous fistulas (AVFs) with retrograde leptomeningeal venous drainage. Of 92 patients with intracranial dural AVF, 14 underwent combined surgical and endovascular treatment. Dural AVF was located in the cavernous sinus in two, the petrotentorial region in one, and the transverse-sigmoid sinus in 11. Characteristic features of the patients were retrograde leptomeningeal venous drainage and obstruction of transvenous access routes. All the patients were treated with combined transarterial embolisation and surgical procedures including craniotomy and sinus packing with coils, or clipping of the draining vein. Dural AVF was completely obliterated in all patients without obvious neurologic complications. In the mean follow-up period of 4.2 years, a new dural AVF on the cortex adjacent to the treated sinus developed in one patient. Combined surgical and endovascular treatment is effective for the treatment of high-risk dural AVFs.
authors.affiliation: Department of Neurosurgery, Toyama Medical and Pharmaceutical University, Japan. kuwayama@ms.toyama-mpu.ac.jp
authors.forename: Naoya
authors.initials: N
authors.lastname: Kuwayama
authors.forename: Michiya
authors.initials: M
authors.lastname: Kubo
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelaal
authors.forename: Masanori
authors.initials: M
authors.lastname: Kurimoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hirashima
authors.forename: Shunro
authors.initials: S
authors.lastname: Endo
mesh_terms: D000368:Aged; D002426:Cavernous Sinus / Q000000981:diagnostic imaging / Q000601:surgery; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery* / Q000628:therapy*; D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000601:surgery; D003131:Combined Modality Therapy; D003399:Craniotomy; D004388:Dura Mater / Q000098:blood supply / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008578:Meninges / Q000098:blood supply / Q000000981:diagnostic imaging; D008875:Middle Aged; D012307:Risk Factors; D014656:Vascular Surgical Procedures