The role of surgery for high-grade intracranial dural arteriovenous fistulas: Importance of obliteration of venous outflow. Clinical article

James K. Liu, Aclan Dogan, Dilantha B. Ellegala, Jonathan Carlson, Gary M. Nesbit, Stanley L. Barnwell, Johnny B. Delashaw

Research output: Contribution to journalArticle

54 Scopus citations


Object. Surgical intervention may be required if endovascular embolization is insufficient to completely obliterate intracranial dural arteriovenous fistulas (DAVFs). The authors report their 14-year experience with 23 patients harboring diverse intracranial DAVFs that required surgical intervention. Methods. Between 1993 and 2007, 23 patients underwent surgery for intracranial DAVFs. The following types of DAVFs were treated: superior petrosal sinus (in 10 patients); parietooccipital (in 3); confluence of sinuses and ethmoidal (in 2 each); and tentorial, falcine, occipital, transverse-sigmoid, superior sagittal, and cavernous sinuses (in 1 patient each). In all cases, the authors' goal was to obliterate the DAVF venous outflow by direct surgical interruption of the leptomeningeal venous drainage. Transarterial embolization was used primarily as an adjunct to decrease flow to the DAVF prior to definitive treatment. Results. Complete angiographic obliteration of the DAVF was achieved in all cases. There were no complications of venous hypertension, venous infarction, or perioperative death. There were no recurrences and no further clinical events (new hemorrhages or focal neurological deficits) after a mean follow-up of 45 months. Conclusions. The authors' experience emphasizes the importance of occluding venous outflow to obliterate intracranial DAVFs. Those that drain purely through leptomeningeal veins can be safely obliterated by surgically clipping the arterialized draining vein as it exits the dura. Radical excision of the fistula is not necessary.

Original languageEnglish (US)
Pages (from-to)913-920
Number of pages8
JournalJournal of neurosurgery
Issue number5
StatePublished - May 1 2009



  • Dural arteriovenous fistula
  • Leptomeningeal venous drainage
  • Surgical occlusion
  • Transvenous embolization
  • Venous outflow

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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