title: Surgical disconnection of the cortical venous reflux for high-grade intracranial dural arteriovenous fistulas.
abstract: OBJECTIVE
  To assess the clinical outcome, complications, and angiographic outcomes after surgical disconnection of intracranial dural arteriovenous fistulas (DAVFs).
  
  
  METHODS
  Analysis of prospectively collected data, including clinical presentation, preoperative angiographic findings, postoperative complications, clinical, and angiographic outcomes.
  
  
  RESULTS
  Between January 2002 and January 2012, 25 patients underwent surgery for DAVFs. The anatomical locations included tentorial (8), ethmoidal (8), foramen magnum (5), middle fossa (2), torcular (1), and parafalcine (1). All had cortical venous reflux (CVR) and all were treated with craniotomy and disconnection of CVR. Two patients required repeat surgery for residual CVR. One patient had a postoperative seizure. There were no other complications. All patients had complete disconnection of CVR confirmed by digital subtraction angiography. None of the patients have had hemorrhage or recurrence of CVR on follow-up.
  
  
  CONCLUSIONS
  Surgical disconnection of CVR for high-grade intracranial DAVFs is highly effective and can be performed with very low complication rates. Where embolization cannot be performed safely, surgical disconnection (rather than stereotactic radiosurgery) is the treatment of choice for high grade DAVFs.
authors.affiliation: Department of Neurosurgery, the Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, United Kingdom. Electronic address: rafidalmahfoudh@yahoo.com.
authors.forename: Rafid
authors.initials: R
authors.lastname: Al-Mahfoudh
authors.affiliation: Department of Neurosurgery, Addenbrook's Hospital, Cambridge, United Kingdom.
authors.forename: Ramez
authors.initials: R
authors.lastname: Kirollos
authors.affiliation: Department of Neurosurgery, the Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: Department of Neurosurgery, the Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Maggie
authors.initials: M
authors.lastname: Lee
authors.affiliation: Department of Neuroradiology, the Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, United Kingdom.
authors.forename: Hans
authors.initials: H
authors.lastname: Nahser
authors.affiliation: Department of Neurosurgery, the Walton Centre for Neurology and Neurosurgery NHS Foundation Trust, Liverpool, United Kingdom; Department of Neurosurgery, National Neurosurgical Centre, Beaumont Hospital, Dublin, Ireland.
authors.forename: Mohsin
authors.initials: M
authors.lastname: Javadpour
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D020785:Central Nervous System Vascular Malformations / Q000601:surgery*; D002550:Cerebral Veins / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Borden; Cognard; Cortical venous reflux; Dural arteriovenous fistula; Surgical disconnection