caa a22 4500 445329084 CHVBK 20180317142731.0 cr unu---uuuuu 170323e20110701xx s 000 0 eng 10.1007/s10143-011-0318-5 doi (NATIONALLICENCE)springer-10.1007/s10143-011-0318-5 Microsurgery can cure most intracranial dural arteriovenous fistulae of the sinus and non-sinus type [Elektronische Daten] [Dorothee Wachter, Franz Hans, Marios-Nikos Psychogios, Michael Knauth, Veit Rohde] There is consensus that intracranial dural arteriovenous fistulae (dAVF) with direct (non-sinus-type) or indirect (sinus-type) retrograde filling of a leptomeningeal vein should be treated due to the high risk of neurological deficits and hemorrhage. No consensus exists on treatment modality (surgery and/or embolization) and, if surgery is performed, on the best surgical strategy. This series aims to evaluate the role of surgery in the management of aggressive dAVFs. Forty-two patients underwent surgery. Opening and packing the sinus with thrombogenic material was performed in 9 of the 12 sinus-type dAVFs. In two sinus-type fistulae of the cavernous sinus and 1 of the torcular, microsurgery was used as prerequisite for subsequent embolization by providing access to the sinus. In the 30 non-sinus-type dAVFs, surgery consisted of interruption of the draining vein at the intradural entry point. In 41 patients undergoing 43 operations, elimination of the dAVF was achieved (97.6%). In one case, a minimal venous drainage persisted after surgery. The transient surgical morbidity was 11.9% (n = 5) and the permanent surgical morbidity 7.1% (n = 3). Our surgical strategy was to focus on the arterialized leptomeningeal vein in the non-sinus-type and on the arterialized sinus segment in the sinus-type dAVFs allowing us to obliterate all but one dAVF with a low morbidity rate. We therefore propose that microsurgery should be considered early in the treatment of both types of aggressive dAVFs. In selected cases of cavernous sinus dAVFs, the role of microsurgery is reduced to that of an adjunct to endovascular therapy. The Author(s), 2011 Intracranial dural arteriovenous fistulae nationallicence dAVF nationallicence Sinus-type fistula nationallicence Non-sinus-type fistula nationallicence Surgical strategies nationallicence Wachter Dorothee Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany aut Hans Franz Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany aut Psychogios Marios-Nikos Department of Neuroradiology, Georg-August-University Göttingen, Göttingen, Germany aut Knauth Michael Department of Neuroradiology, Georg-August-University Göttingen, Göttingen, Germany aut Rohde Veit Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany aut Neurosurgical Review Springer-Verlag 34/3(2011-07-01), 337-345 0344-5607 34:3<337 2011 34 10143 https://doi.org/10.1007/s10143-011-0318-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10143-011-0318-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Wachter Dorothee Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany aut NATIONALLICENCE 700 1- Hans Franz Department of Neurosurgery, University Hospital RWTH Aachen, Aachen, Germany aut NATIONALLICENCE 700 1- Psychogios Marios-Nikos Department of Neuroradiology, Georg-August-University Göttingen, Göttingen, Germany aut NATIONALLICENCE 700 1- Knauth Michael Department of Neuroradiology, Georg-August-University Göttingen, Göttingen, Germany aut NATIONALLICENCE 700 1- Rohde Veit Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany aut NATIONALLICENCE 773 0- Neurosurgical Review Springer-Verlag 34/3(2011-07-01), 337-345 0344-5607 34:3<337 2011 34 10143 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer