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

Je Hun Jang, Won Sang Cho, Hyun-Seung Kang, Jeong Eun Kim

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: 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. Methods: 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). Results: 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)89-94
Number of pages6
JournalWorld Neurosurgery
Volume130
DOIs
StatePublished - 1 Oct 2019

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Anterior Cranial Fossa
Central Nervous System Vascular Malformations
Craniotomy
Aneurysm
Veins
Arteries
Frontal Sinus
Cerebral Angiography
Neurologic Manifestations
Fistula
Hemorrhage
Bone and Bones

Keywords

  • Anterior cranial fossa
  • Dural arteriovenous fistula
  • Frontal
  • Frontobasal
  • Surgical obliteration

Cite this

@article{f8d67914933040cc811ea59ba806f101,
title = "Surgical Obliteration of Anterior Cranial Fossa Dural Arteriovenous Fistulas via Unilateral High Frontal Craniotomy",
abstract = "Background: 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. Methods: 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). Results: 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. Conclusions: 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.",
keywords = "Anterior cranial fossa, Dural arteriovenous fistula, Frontal, Frontobasal, Surgical obliteration",
author = "Jang, {Je Hun} and Cho, {Won Sang} and Hyun-Seung Kang and Kim, {Jeong Eun}",
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Surgical Obliteration of Anterior Cranial Fossa Dural Arteriovenous Fistulas via Unilateral High Frontal Craniotomy. / Jang, Je Hun; Cho, Won Sang; Kang, Hyun-Seung; Kim, Jeong Eun.

In: World Neurosurgery, Vol. 130, 01.10.2019, p. 89-94.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Surgical Obliteration of Anterior Cranial Fossa Dural Arteriovenous Fistulas via Unilateral High Frontal Craniotomy

AU - Jang, Je Hun

AU - Cho, Won Sang

AU - Kang, Hyun-Seung

AU - Kim, Jeong Eun

PY - 2019/10/1

Y1 - 2019/10/1

N2 - Background: 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. Methods: 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). Results: 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. Conclusions: 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.

AB - Background: 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. Methods: 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). Results: 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. Conclusions: 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.

KW - Anterior cranial fossa

KW - Dural arteriovenous fistula

KW - Frontal

KW - Frontobasal

KW - Surgical obliteration

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DO - 10.1016/j.wneu.2019.06.206

M3 - Article

VL - 130

SP - 89

EP - 94

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -