Single stage transcranial exposure of large dural venous sinuses for surgically-assisted direct transvenous embolization of high-grade dural arteriovenous fistulas: Technical note

James K. Liu, Osamah J. Choudhry, Stanley L. Barnwell, Johnny B. Delashaw, Aclan Dogan

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: High-grade dural arteriovenous fistulas (DAVFs) with retrograde cortical leptomeningeal drainage are formidable lesions because of their risk for intracranial hemorrhage. Treatment is aimed at occluding venous outflow to achieve obliteration of the fistula. In DAVFs that involve a large dural venous sinus (transverse sigmoid sinus or superior sagittal sinus), occluding venous outflow can be accomplished endovascularly with transvenous embolization. However, in some cases of DAVFs with reflux into cortical leptomeningeal veins, there may be venous restrictive disease downstream, such as occlusive thrombosis, which can prohibit endovascular access via the transfemoral or transjugular routes. In these instances, a transcranial approach can be performed to expose the large dural venous sinus distal to the site of occlusion for direct catheterization of the venous outflow for transvenous embolization. This combined surgical and endovascular strategy provides direct access to the venous outflow and bypasses the site of thrombotic obstruction. Methods: In this report, we describe our technique of single stage surgically-assisted transvenous embolization in three patients with high-grade DAVFs involving a large dural sinus. Results: All patients achieved complete obliteration of their DAVFs without any venous related complications. Conclusion: Our technique of surgically-assisted direct transvenous embolization of high-grade DAVFs can be successfully performed as a single stage in the operating room with intraoperative angiography and stereotactic image guidance.

Original languageEnglish (US)
Pages (from-to)1855-1859
Number of pages5
JournalActa Neurochirurgica
Volume154
Issue number10
DOIs
StatePublished - Oct 2012

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Central Nervous System Vascular Malformations
Superior Sagittal Sinus
Transverse Sinuses
Intracranial Hemorrhages
Sigmoid Colon
Operating Rooms
Catheterization
Fistula
Drainage
Veins
Angiography
Thrombosis

Keywords

  • Dural arteriovenous fistula
  • Surgical treatment
  • Transvenous embolization
  • Venous outflow

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Single stage transcranial exposure of large dural venous sinuses for surgically-assisted direct transvenous embolization of high-grade dural arteriovenous fistulas : Technical note. / Liu, James K.; Choudhry, Osamah J.; Barnwell, Stanley L.; Delashaw, Johnny B.; Dogan, Aclan.

In: Acta Neurochirurgica, Vol. 154, No. 10, 10.2012, p. 1855-1859.

Research output: Contribution to journalArticle

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AB - Background: High-grade dural arteriovenous fistulas (DAVFs) with retrograde cortical leptomeningeal drainage are formidable lesions because of their risk for intracranial hemorrhage. Treatment is aimed at occluding venous outflow to achieve obliteration of the fistula. In DAVFs that involve a large dural venous sinus (transverse sigmoid sinus or superior sagittal sinus), occluding venous outflow can be accomplished endovascularly with transvenous embolization. However, in some cases of DAVFs with reflux into cortical leptomeningeal veins, there may be venous restrictive disease downstream, such as occlusive thrombosis, which can prohibit endovascular access via the transfemoral or transjugular routes. In these instances, a transcranial approach can be performed to expose the large dural venous sinus distal to the site of occlusion for direct catheterization of the venous outflow for transvenous embolization. This combined surgical and endovascular strategy provides direct access to the venous outflow and bypasses the site of thrombotic obstruction. Methods: In this report, we describe our technique of single stage surgically-assisted transvenous embolization in three patients with high-grade DAVFs involving a large dural sinus. Results: All patients achieved complete obliteration of their DAVFs without any venous related complications. Conclusion: Our technique of surgically-assisted direct transvenous embolization of high-grade DAVFs can be successfully performed as a single stage in the operating room with intraoperative angiography and stereotactic image guidance.

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