gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Surgical management of dural arteriovenous fistulas (DAVFs) with feeding arteries involving the occipital condyle and the jugular foramen

Das chirurgische Management von duralen arteriovenösen Fisteln (DAVFs) mit arteriellen Zuflüssen, die den Condylus occipitalis und das Foramen jugulare einbeziehen

Meeting Abstract

  • corresponding author L. Benes - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg
  • W. Tirakotai - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg
  • T. Riegel - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg
  • C. Kappus - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg
  • U. Sure - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg
  • S. Bien - Abteilung für Neuroradiologie, Universitätsklinikum Gießen und Marburg
  • H. Bertalanffy - Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg

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. DocSA.05.03

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc115.shtml

Published: May 8, 2006

© 2006 Benes et al.
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Outline

Text

Objective: Dural arteriovenous fistulas (DAVFs), partially with feeding arteries located in bony structures around the occipital condyle and the jugular foramen are complex vascular malformations and belong to the most challenging skull base lesions to treat. A consecutive series of patients with multiple features in a series of DAVFs involving bony structures around the foramen magnum were comprehensively evaluated.

Methods: Four consecutive patients were treated microsurgically via the far lateral approach for DAVFs with osseus feeders around the occipital condyle and the jugular foramen in our department. The charts and videos of these individuals were reviewed retrospectively to analyze surgical strategies in the management of these complex vascular lesions. Obliteration of the DAVFs were postoperatively confirmed by angiography in all patients.

Results: Complete obliteration of the dural arteriovenous fistulas (DAVFs) was achieved in three and significant flow reduction in one individual. All patients had good outcomes (Glasgow outcome scale 4 or 5). One individual experienced treatment-associated mild hypoglossal nerve palsy. The treatment mortality rate was zero. As a consequence of extensive bilateral drilling of the occipital condyle, an occipito-cervical fusion was necessary in one patient with a lesions involving both condyles.

Conclusions: For a total occlusion in DAVFs partially supplied by arteries within bony structures around the foramen magnum, the far lateral approach should be considered an elegant armamentarium that improves the occlusion-rate of this challenging vascular lesions most effectively.