gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Transcranial approach for surgical-combined-endovascular treatment of a cavernous dural arteriovenous fistula: the superficial sylvian vein route. Case report

Meeting Abstract

  • corresponding author F. Badaloni - Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
  • A. Fioravanti - Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
  • S. Bartolini - Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
  • A. Bertuccio - Department of Neurosurgery, Bellaria Hospital, Bologna, Italy
  • M. Leonardi - Department of Neuroradiology, Bellaria Hospital, Bologna, Italy
  • F. Calbucci - Department of Neurosurgery, Bellaria Hospital, Bologna, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocP 067

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Badaloni et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The decision to treat and how to treat dural arteriovenous fistulas (DAVFs) depends mostly on the venous drainage pattern and the severity of presenting symptoms. Clinical and neuroradiological observation, transarterial embolization of feeders vessels, transvenous embolization and surgical obliteration can be considered in the management. Transvenous embolization has become the treatment of choice for such lesions. We discuss a case report of surgical-combined-endovascular treatment of a cavernous dural AV fistula.

Methods: 39-year-old male presented with one year history of deteriorating proptosis and chemosis in the right eye. A digital subtraction angiography (DSA) demonstrated a cavernous dural arteriovenous fistula with meningeal feeders from bilateral ICAs and right ECA. Classification: type D (Barrow 1985); type IIa + b (Cognard 1995) and type IIa (Borden 1995). As a consequence of the venous drainage with documented sphenoparietal sinus hypertension and arterialization of the sylvian vein the patient was proposed for surgical-endovascular treatment. Transcranial right pterional approach, exposure of a very large and arterialized superficial sylvian vein-sphenoparietal sinus complex; then puncture of the sylvian vein and indirect catheterization of the CV that was then embolized with three coils (n°2 GDC 360° 10X30; n°1 GDC fibered 2X5) under fluoroscopic control. At the end of the endovascular time, surgical cauterization of the superficial sylvian vein, the temporo-polar vein and the medial sphenoparietal sinus was performed.

Results: The fistula was completely occluded as documented by an early (3-days) post-treatment magnetic resonance angiography (MRA) that even documented a right parietal hemorrhage clinically silent. We assisted to a progressive resolution of exophthalmos and chemosis without neurological sequelae. A late (10-days) DSA confirmed the occlusion of the fistula. Excellent clinical outcome after 6 months.

Conclusions: The surgical-endovascular treatment of cavernous DAVFs with puncture of the superficial sylvian vein could be an important option in selected cases.