Utilization of Mixed Reality in the Surgical Management of Dural Arteriovenous Fistulas with Cortical Venous Reflux: A Case Series

Background: Dural arteriovenous fistulas (dAVFs) with cortical venous drainage (CVD. are high-risk vascular malformations requiring prompt intervention. While endovascular approaches are often effective, surgical management is crucial in cases refractory to or unsuitable for endovascular treatment. This study evaluates the efficacy of Mixed Reality (MxR) in enhancing surgical outcomes in cases where endovascular options were not viable.

Methods: A retrospective case series of four high-risk dAVF patients was conducted. Preoperative planning utilized patient-specific 360VR models, while intraoperative guidance employed Augmented reality (AR) markers for targeted fistulous point disconnection. The angioarchitecture of the dAVFs was considered a significant factor in determining the treatment approach.

Results: All cases resulted in successful resection or resolution of the dAVF, with an average surgery duration of 3 hours and 17 minutes and an average blood loss of 81.25 mL. No postoperative deficits were noted. VR was crucial for preoperative marking of the fistulous point and placement planning of the targeted craniotomies. AR provided an inside-out calvarial view and played a critical role in localizing the fistulous point during surgery. This facilitated the take-down of the fistula.

Conclusions: MxR technologies show promise in enhancing surgical precision and outcomes for dAVFs. These results highlight the importance of surgical approaches when endovascular options are limited or have failed. Further research is needed to validate these findings.

Publication History

Article published online:
05 February 2024