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57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. bis 14.05.2006, Essen

Microsurgical management of dural arteriovenous malformations of the anterior cranial fossa

Mikrochirurgische Behandlung frontobasaler duraler arteriovenöser Fisteln

Meeting Abstract

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  • corresponding author M.C. Korinth - Neurochirurgische Klinik, Universitätsklinikum der RWTH, Aachen
  • B. C. Huffmann - Neurochirurgische Klinik, Universitätsklinikum der RWTH, Aachen
  • J. M. Gilsbach - Neurochirurgische Klinik, Universitätsklinikum der RWTH, Aachen

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 09.147

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Veröffentlicht: 8. Mai 2006

© 2006 Korinth et al.
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Objective: Anterior cranial fossa dural arteriovenous fistulas (DAVFs), unlike those in other locations, form a rare and distinct subgroup among all dural arteriovenous malformations (AVMs), which themselves contribute 10-15% of all intracranial AVMs. Congenital or acquired, they are of particular interest for the neurosurgeon not only because of their unique localisation, arterial supply and venous drainage, but also because of their extraordinary high tendency for bleeding. Therefore, microsurgical occlusion is favorized in contrast to endovascular therapy and radiosurgery.

Methods: Sixteen patients with DAVFs were treated during a 17-year period from 1988 to 2004. In 12 patients the fistula was exposed, coagulated and divided microsurgically. In the first two patients the malformations was approached via a frontobasal craniotomy, in the 10 succeeding patients an interhemispheric approach was chosen. The mean age of the 8 male and 4 female patients was 59 years (35-73). Neuronavigation was used in 2 patients to facilitate localization of the fistula.

Results: Preoperative angiography revealed arterial supply of the DAVF by ethmoidal branches of the ophthalmic artery in all cases. The fistula was interrupted successfully in 10 cases during the first operative procedure. In two cases, both with neuronavigation during the first procedure, complete interruption was possible only in a second operation. There were no complications related to the surgical procedure in the patients operated on via an interhemispheric approach. In one of the two patients with a frontobasal craniotomy, a pneumatocephalus requiring reoperation, and in the other an unilateral damage of the olfactory nerve resulting in hyposmia was seen.

Conclusions: The microsurgical interhemispheric approach for the intradural obliteration of DAVF’s of the anterior cranial fossa, is a technically simple, effective and successful technique, and is therefore a recommendable alternative for the management of this rare subgroup of AVM’s. Neuronavigation might be helpful for this route, which avoids some disadvantages of the more frequently reported frontobasal approach.