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Minim Invasive Neurosurg 2000; 43(3): 138-143
DOI: 10.1055/s-2000-8334
ORIGINAL PAPER
Georg Thieme Verlag Stuttgart · New York

Combined Endovascular-Microsurgical Treatment of Tentorial-Incisural Dural Arteriovenous Malformations. Report of Five Cases

E. van Lindert1 , W. Hassler1 , D. Kühne2 , H. Henkes2
  • 1Neurosurgical Department, Klinikum Duisburg, Wedau Kliniken, Germany
  • 2Radiological Department, Alfried Krupp Krankenhaus, Essen, Germany
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Publication History

Publication Date:
31 December 2000 (online)

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Dural arteriovenous malformations of the tentorial edge are rare lesions with an unfavorable clinical course if left untreated. As yet no optimum treatment has been established. We retrospectively evaluated the results of our therapy concept, which consists of endovascular embolization followed by microsurgical obliteration, and compared the results to the relevant literature in order to clarify which therapeutic regimen seems to be optimum at the present time. In all of our five patients the lesion was completely obliterated, as proven by angiography, with favorable clinical results and low morbidity. Several other clinical series confirm our results, so we conclude that combined endovascular therapy and microsurgery is the optimum treatment for these lesions.

Key words:

Dural Arteriovenous Malformation - Dural Arteriovenous Fistula - Microsurgery - Endovascular Treatment - Tentorial-Incisural

References

  • 1 Augustin P, Daluzeau N, Dujardin M. et al . Fistule artério-veineuse duremérienne et occlusion du sinus latéral.  Rev Neurol (Paris). 1984;  140 594-596
    PubMedGoogle Scholar
  • 2 Awad I A, Little J R. Dural arteriovenous malformations. In: Barrow DL (ed.). Intracranial Vascular Malformations Park Ridge, ILL: AANS 1990: 219-226
    Google Scholar
  • 3 Awad I A. Tentorial incisura and brain stem dura arteriovenous malformations. In: Awad IA, Barrow DL (eds.). Dural Arteriovenous Malformations Illinois: AANS, Park Ridge 1993: 131-146
    Google Scholar
  • 4 Barnwell S. Endovascular therapy of dural arteriovenous malformations. In: Awad IA, Barrow DL (eds.). Dural Arteriovenous Malformations Illinois: AANS, Park Ridge 1993: 194
    Google Scholar
  • 5 Borden J A, Wu J K, Shucart W A. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment.  J Neurosurg. 1995;  82 166-179
    CrossrefPubMedGoogle Scholar
  • 6 Brismar G, Brismar J. Spontaneous carotid-cavernous fistulas: phlebographic appearance and relation to thrombosis.  Acta Radiol Diagn. 1976;  17 180-192
    PubMedGoogle Scholar
  • 7 Brown R D, Wiebers D O, Nichols D A. Intracranial dural arteriovenous fistulae: angiographic predictors of intracranial hemorrhage and clinical outcome in nonsurgical patients.  J Neurosurg. 1994;  81 531-538
    CrossrefPubMedGoogle Scholar
  • 8 Chaudhary M Y, Sachdev V P, Cho S H. et al . Dural arteriovenous malformation of the major venous sinuses: an acquired lesion.  AJNR. 1982;  3 13-19
    PubMedGoogle Scholar
  • 9 Davies M A, TerBrugge K, Willinsky R, Coyne T, Saleh J, Wallace M C. The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas.  J Neurosurg. 1996;  85 830-837
    CrossrefPubMedGoogle Scholar
  • 10 Duffau H, Lopes M, Janosevic V, Sichez J-P, Faillot T, Capelle L, Ismaïl M, Bitar A, Arthuis F, Fohanno D. Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature.  J Neurosurg. 1999;  90 78-84
    CrossrefPubMedGoogle Scholar
  • 11 Fardoun R, Adam Y, Mercier P. et al . Tentorial arteriovenous malformations presenting as an intracerebral hematoma: case report.  J Neurosurg. 1981;  55 976-978
    PubMedGoogle Scholar
  • 12 Grisoli F, Vincentelli F, Fuchs S. et al . Surgical treatment of tentorial arteriovenous malformations draining into the subarachnoid space.  J Neurosurg. 1984;  60 1059-1066
    PubMedGoogle Scholar
  • 13 Halbach V V, Higashida R T, Hieshima G B, Wilson C B, Hardin C W, Kwan E. Treatment of dural fistulas involving the deep cerebral venous system.  AJNR. 1989;  10 393-399
    PubMedGoogle Scholar
  • 14 Handa J, Yoneda S, Handa H. Venous sinus occlusion with a dural arteriovenous malformation of the posterior fossa.  Surg Neurol. 1975;  4 433-437
    PubMedGoogle Scholar
  • 15 Hoh B L, Choudhri T F, Connolly Jr E S, Solomon R A. Surgical management of high-grade intracranial dural arteriovenous malformations: leptomeningeal venous disruption without nidus excision.  Neurosurg. 1998;  42 796-804
    PubMedGoogle Scholar
  • 16 Houser O W, Campbell J K, Campbell R J. et al . Arteriovenous malformations affecting the transverse dural venous sinus: an acquired lesion.  Mayo Clin Proc. 1979;  54 651-661
    PubMedGoogle Scholar
  • 17 Lewis A I, Tomsick T A, Tew J M. Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery.  J Neurosurg. 1994;  81 851-859
    CrossrefPubMedGoogle Scholar
  • 18 Lewis A I, Rosenblatt S S, Tew J M. Surgical management of deep-seated dural arteriovenous malformations.  J Neurosurg. 1997;  87 198-206
    PubMedGoogle Scholar
  • 19 Link M J, Coffey R J, Nichols D A, Gorman D A. The role of radiosurgery and particulate embolization in the treatment of dural arteriovenous fistulas.  J Neurosurg. 1996;  84 804-809
    CrossrefPubMedGoogle Scholar
  • 20 Lucas C P, Zabramski J M, Spetzler R F, Jacobowitz R. Treatment for intracranial dural arteriovenous malformations: a meta-analysis from the English language literature.  Neurosurg. 1997;  40 1119-1130
    CrossrefPubMedGoogle Scholar
  • 21 Nabors M W, Azzam C J, Albanna F J. et al . Delayed postoperative dural arteriovenous malformations: report of two cases.  J Neurosurg. 1987;  66 768-722
    CrossrefPubMedGoogle Scholar
  • 22 Nicola G C, Nizzoli V. Dural arteriovenous malformations of the posterior fossa.  J Neurol Neurosurg Psychiatry. 1968;  31 514-519
    PubMedGoogle Scholar
  • 23 Picard L, Bracard S, Islak C, Roy D, Moreno A, Marchal J C, Roland J. Dural fistulae of the tentorium cerebelli. Radioanatomical, clinical and therapeutic considerations.  J Neuroradiol. 1990;  17 161-181
    PubMedGoogle Scholar
  • 24 Pierot L, Chiras J, Meder J-F, Rose M, Rivierez M, Marsault C. Dural arteriovenous fistulas of the posterior fossa draining into subarachnoid veins.  AJNR. 1992;  13 315-323
    PubMedGoogle Scholar
  • 25 Watanabe A, Takahara Y, Ibuchi Y. et al . Two cases of dural arteriovenous malformation occurring after intracranial surgery.  Neuroradiology. 1984;  26 375-380
    CrossrefPubMedGoogle Scholar

Corresponding Author

E van Lindert,M.D 

Neurosurgical Department University Hospital Nijmegen St. Radboud

Postbus 9101 6500 HB Nijmegen The Netherlands

Phone: Phone:+31243613477

Fax: Fax:+31233541587

Email: E-mail:vanlindert.will@planet.n