Combined surgical approach with intraoperative endovascular embolization for inaccessible dural arteriovenous fistulas

BackgroundWe describe an alternative treatment modality for inaccessible intracranial DAVFs caused by local thrombosis or tortuous feeder vessels. Special consideration is given to the efficacy of intraoperative endovascular embolization and to the use of various operative routes depending on the location of the lesions.MethodsBetween August 1999 and January 2006, 7 of 65 patients were diagnosed with DAVFs with the limitation of endovascular access. Thus, we adopted a combined surgical approach with intraoperative endovascular embolization. We reviewed and analyzed the patients' medical records and their outcomes.ResultsDepending on tumor location, a surgical approach combined with simultaneous intraoperative endovascular embolization was successfully performed via the SOV, the TS-SS junction, and the SSS. No complication related to the treatment was reported, and, subsequently, all the patients recovered completely.ConclusionA combined surgical approach with simultaneous intraoperative embolization is an effective and safe treatment for DAVFs that are of limited angiographic access.