Combining endovascular and neurosurgical treatments of high-risk dural arteriovenous fistulas in the lateral sinus and the confluence of the sinuses

Katsuya Goto, Prijo Sidipratomo, Noboru Ogata, Toru Inoue, Haruo Matsuno

Research output: Contribution to journalArticlepeer-review

78 Citations (Scopus)

Abstract

Object. The authors describe the use of a systemic approach to treat dural arteriovenous fistulas (DAVFs) in the lateral sinus and the confluence of sinuses in 17 patients who presented with signs and symptoms related to intracranial hemorrhage, infarction, and diffuse brain swelling. Methods. Angiographic examination revealed three different types of DAVFs in these high-risk patients: 1) extremely high flow DAVF not associated with sinus occlusion or leptomeningeal retrograde venous drainage (LRVD); 2) localized DAVF with exclusive LRVD and without sinus occlusion; and 3) diffuse DAVF with sinus occlusion and LRVD. Because of the Complex nature of these lesions, the authors adopted a staged protocol in which they combined endovascular and surgical treatments. Conclusions. The authors believe that by close collaboration between endovascular therapists and vascular neurosurgeons, high-risk DAWs in the lateral sinus and the confluence of sinuses can be successfully managed without treatment-related morbidity and mortality.

Original languageEnglish
Pages (from-to)289-299
Number of pages11
JournalJournal of Neurosurgery
Volume90
Issue number2
DOIs
Publication statusPublished - Feb 1999

Keywords

  • Combined treatment
  • Dural arteriovenous fistula
  • Embolization
  • Sigmoid sinus
  • Surgery
  • Transverse sinus

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