Download PDF
Minim Invasive Neurosurg 2001; 44(4): 205-210
DOI: 10.1055/s-2001-19932
Original Article
Georg Thieme Verlag Stuttgart · New York

Treatment of Dural Arteriovenous Fistulae (dAVF's) at the Superior Sagittal Sinus (SSS) Using Embolisation Combined with Micro- or Radiosurgery

A.  Bertalanffy1 , W.  Dietrich1 , K.  Kitz1 , G.  Bavinzski1
  • 1Department of Neurosurgery, University of Vienna, Medical School, Vienna, Austria
Further Information

Publication History

Publication Date:
01 February 2002 (online)

    Permissions and Reprints

Abstract

DAVF's at the SSS are extremely rare and usually present with intracranial haemorrhage (ICH) or a progressive neurological deficit. Due to their midline location and multiple arterial supply, endovascular treatment alone often fails in eliminating the fistula. Therefore, endovascular, combined with neurosurgical and/or radiosurgical treatment is often needed to cure the patient. We summarized our experience with three male patients over a ten-year period who suffered from dAVF's involving the middle and posterior third of the SSS. Two of them presented with an ICH during the clinical course. Despite multiple transarterial embolisations, complete fistula occlusion could not be achieved in any of them. Nevertheless, neurological symptoms improved in all cases. One patient refused further treatment and died six years later due to an ICH. Another patient was finally cured by microsurgical coagulation of the fistula. In the remaining patient stereotactic radiosurgery (SRS) was performed after nearly complete endovascular occlusion. We strongly recommend microsurgery and/or radiosurgery as adjunctive measures, if embolisation alone fails to eliminate these dangerous fistulae.

Key words

Dural Arteriovenous Fistula - Superior Sagittal Sinus - Embolisation - Microsurgery - Stereotactic Radiosurgery - Gamma Knife

References

  • 1 Cognard C, Gobin  Y P, Pierot L P, Bailly A L, Houdard E, Casasco A, Chiras J, Merland J J. Cerebral dural arteriovenous fistulas: Clinical and angiographic correlation with a revised classification of venous drainage.  Radiology. 1995;  194 671-680
    CrossrefPubMedGoogle Scholar
  • 2 Newton T, Cronqvist S. Involvement of the dural arteries in intra-cranial arteriovenous malformations.  Radiology. 1969;  90 27-35
    PubMedGoogle Scholar
  • 3 Bavinzski G, Richling B, Killer M, Gruber A, Levy D. Evolution of different therapeutic strategies in the treatment of cranial dural arteriovenous fistulas - Report of 30 cases.  Acta Neurochir (Wien). 1996;  138 132-138
    CrossrefPubMedGoogle Scholar
  • 4 Brown Jr R D, Wiebers D O, Nichols D A. Intracranial dural arteriovenous fistulae: angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients.  J Neurosurg. 1994;  81 531-538
    CrossrefPubMedGoogle Scholar
  • 5 Awad I A, Little J R, Akrawi W P, Ahl J. Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course.  J Neurosurg. 1990;  72 839-850
    CrossrefPubMedGoogle Scholar
  • 6 Halbach V V, Higashida R T, Hieshima G B, David F D. Endovascular therapy of dural fistulas.  In: Vinuela F (ed). Interventional neuroradiology: Endovascular therapy of the central nervous system. New York: Raven 1992: 29-50
    Google Scholar
  • 7 Picard L, Bracard S, Moret J, Pez A, Giacotte H L, Roland J. Spontaneous dural arteriovenous fistulas.  Seminars in interventional radiology. 1987;  4 219-241
    PubMedGoogle Scholar
  • 8 Gaston A, Chiras J, Bourbotte G, Leger J M, Guibert-Tranier F, Merland J J. Meningeal arteriovenous fistulae draining into cortical veins.  J Neuroradiology. 1984;  11 161-177
    PubMedGoogle Scholar
  • 9 Chaudahary M Y, Sachdev V P, Cho S H, Weitzner Jr I, Puljic S, Huang Y P. Dural arteriovenous malformation of the major venous sinuses: An acquired lesion.  AJNR. 1982;  3 13-19
    PubMedGoogle Scholar
  • 10 Halbach V V, Higashida R T, Hieshima G B, Rosenblum M, Cahan L. Treatment of dural arteriovenous malformations involving the superior sagittal sinus.  AJNR. 1988;  9 337-343
    PubMedGoogle Scholar
  • 11 Roland J, Bernard C, Bracard S. Microvascularisation of the intracranial dura mater.  Surg Radiol Anat. 1987;  9 43-49
    PubMedGoogle Scholar
  • 12 Lasjaunias P, Chiu M, Brugge K T, Tolia A, Hurth M, Bernstein M. Neurological manifestation of intracranial dural arteriovenous malformations.  J Neurosurg. 1986;  64 724-730
    CrossrefPubMedGoogle Scholar
  • 13 Lewis A I, Tomsick T A, Tew Jr J M. Management of tentorial dural arteriovenous malformations: transarterial embolisation combined with stereotactic radiation or surgery.  J Neurosurg. 1994;  81 851-859
    CrossrefPubMedGoogle Scholar
  • 14 Barnwell S L, Halbach V V, Higashida G B, Wilson G B. Complex dural arteriovenous fistulas: Result of combined endovascular and neurosurgical treatment in 16 patients.  J Neurosurg. 1989;  71 352-358
    CrossrefPubMedGoogle Scholar
  • 15 Link M J, Coffey R J, Nichols D A, Gorman D A. The role of radiosurgery and particulate embolisation in the treatment of dural arteriovenous fistulas.  J Neurosurg. 1996;  84 804-809
    CrossrefPubMedGoogle Scholar
  • 16 Sundt Jr T M, Piepgras D G. The surgical approach to arteriovenous malformations of the lateral and sigmoid dural sinuses.  J Neurosurg. 1983;  59 32-39
    PubMedGoogle Scholar
  • 17 Cloft H J, Kallmes D F, Jensen M E, Dion J E. Percutaneous transvenous coil embolisation of a type 4 sagittal sinus dural arteriovenous fistula: Case report.  Neurosurgery. 1997;  41 1191-1193
    PubMedGoogle Scholar
  • 18 Kurl S, Saari T, Vanninen R, Hernesniemi I. Dural arteriovenous fistulas of the superior sagittal sinus: case report and review of the literature.  Surg Neurol. 1996;  45 250-255
    PubMedGoogle Scholar
  • 19 Pierot L, Visot A, Boulin A, Dupuy M. Combined neurosurgical and neuroradiological treatment of a complex superior sagittal sinus dural fistula: Technical note.  Neurosurgery. 1998;  42 194-197
    PubMedGoogle Scholar
  • 20 Guo W Y, Pan D H, Wu H M, Chung W Y, Shiau C Y, Wang L W, Chiou H J, Yen M Y, Teng M M. Radiosurgery as a treatment alternative for dural arteriovenous fistulas of the cavernous sinus.  AJNR. 1998;  19 1081-1087
    PubMedGoogle Scholar
  • 21 Martin N A, King W A, Wilson C B, Nutik S, Carter L P, Spetzler R F. Management of dural arteriovenous malformations of the anterior cranial fossa.  J Neurosurg. 1990;  72 692-697
    PubMedGoogle Scholar
  • 22 Mayfrank L, Reul J, Hoffmann B, Bertalanffy H, Spetzger U, Gilsbach J M. Microsurgical interhemispheric approach to dural arteriovenous fistulas of the floor of the anterior cranial fossa.  Minim Invas Neurosurg. 1996;  39 74-77
    PubMedGoogle Scholar
  • 23 Halbach V V, Higashida R T, Larsen D W, Dowd C F, McDougall C G, Hieshima G B, Wilson C B. Treatment of dural arteriovenous fistulas. In: Maciunas RJ (ed). Endovascular neurological intervention Park Ridge: AANS 1995: 217-246
    Google Scholar
  • 24 Jaeger R. Observations and resections of the superior longitudinal sinus at and posterior to the rolandic inflow.  J Neurosurg. 1951;  8 103-109
    PubMedGoogle Scholar
  • 25 Chandler Jr H C, Friedman W A. Successful radiosurgical treatment of a dural arteriovenous malformation: case report.  Neurosurgery. 1993;  33 139-142
    PubMedGoogle Scholar

A. Bertalanffy,M. D. 

Department of Neurosurgery · University of Vienna · Medical School

Waehringer Guertel 18 - 20

1090 Vienna · Austria

Phone: +43-1-40400-2566

Fax: +43-1-40400-4566

      >