Surgical Obliteration of Anterior Cranial Fossa Dural Arteriovenous Fistulas via Unilateral High Frontal Craniotomy

• Published in: World neurosurgery 2019-10, Vol.130, p.89-94
• Main Authors: Jang, Je Hun, Cho, Won-Sang, Kang, Hyun-Seung, Kim, Jeong Eun
• Format: Article
• Language: English
• Subjects: Central Nervous System Vascular Malformations - diagnostic imaging; Central Nervous System Vascular Malformations - surgery; Cranial Fossa, Anterior - diagnostic imaging; Cranial Fossa, Anterior - surgery; Craniotomy - methods; Female; Humans; Male; Middle Aged
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.06.206

Surgical obliteration is generally recommended for anterior cranial fossa dural arteriovenous fistulas (ACF DAVFs) because of a high risk of bleeding and the difficulty of endovascular approaches. Surgical obliteration is generally performed via a frontobasal craniotomy; however, it is slightly excessive over the target fistula. Here, we present 2 cases of ACF DAVFs treated with small craniotomy without frontal sinus involvement and a review of the related literature. We present 2 cases including a 63-year-old woman who presented with a right-sided ACF DAVF that was fed by both ethmoidal arteries and drained into the right cortical veins (case 1) and a 59-year-old man with right-sided unruptured multiple aneurysms and a left-sided ACF DAVF that was fed by the right ethmoidal artery and drained into the left cortical veins (case 2). Case 1 underwent surgical obliteration via a right high frontal craniotomy. Case 2 was simultaneously treated with surgical clipping of the multiple aneurysms via a right lateral supraorbital craniotomy and surgical obliteration of the ACF DAVF via a left high frontal craniotomy. These 2 patients had no neurologic deficits, and complete obliteration of all the lesions was confirmed on cerebral angiography. Constructing a small corridor and a deep working distance in unilateral small high frontal craniotomy may be a slightly unusual approach; however, it is thought to provide sufficient space and a range of microscopic views that facilitate surgical manipulation without requiring extensive bone work.