Hybrid surgery for dural arteriovenous fistula in the neurosurgical hybrid operating suite.
Treatment of a dural arteriovenous fistula (AVF), which is difficult to access by either the surgical or endovascular approach, is challenging. A hybrid technique, combining a microsurgical approach and endovascular embolization, can provide less invasive management of dural AVFs in a modern neurosurgical hybrid operating suite. We present a case of intracerebral hemorrhage in the left cerebellum secondary to dural AVF, Cognard type IV with numerous tiny feeders from the ascending pharyngeal artery branches. No adequate arterial or venous route for endovascular embolization was found by neuroangiography. The hybrid technique, combining keyhole pterional craniotomy and embolization with n-butyl cyanoacrylate glue injection via direct cannulation of the periclival venous plexus, succeeded in obliterating the dural AVF. Intraoperative angiography showed successful embolization of the dural AVF without any complication. This report illustrates the usefulness of the neurosurgical hybrid operating suite for the treatment of difficult dural AVFs.
Department of Neurosurgery, Triservice General Hospital Songshan Branch, Taiwan Department of Neurosurgery, Taichung Veterans General Hospital, Taiwan.
Shih-Chieh
SC
Shen
Department of Neurosurgery, Taichung Veterans General Hospital, Taiwan Department of Neurosurgery, Triservice General Hospital, National Defense Medical Center, Taiwan.
Yuang-Seng
YS
Tsuei
Department of Neuroradiology, Taichung Veterans General Hospital, Taiwan.
Wen-Hsien
WH
Chen
Department of Neurosurgery, Taichung Veterans General Hospital, Taiwan Department of Neurosurgery, Triservice General Hospital, National Defense Medical Center, Taiwan.
Chiung-Chyi
CC
Shen
D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods*; D009873:Operating Rooms / Q000379:methods*; D011859:Radiography
Fistula; Intervention; Technique