Summary
Background. Despite major advances in endovascular embolization techniques, microsurgical resection remains a reliable and effective treatment modality for dural arteriovenous fistulas (DAVF). However, intraoperative detection of these lesions and identification of feeding arteries and draining veins can be challenging. In a series of 6 patients who were not candidates for definitive treatment by endovascular embolization we evaluated the benefits and limitations of computer-assisted image guidance for surgical ablation of DAVF.
Methods. Of the 6 patients, 5 presented with haemorrhage and one with seizures. Diagnosis of DAVF was made by conventional angiography and dynamic contrast enhanced MR angiography (CE-MRA). All patients were surgically treated with the assistance of a 3D high resolution T1-weighted MR data set and time-of-flight MR angiography (MRA) obtained for neuronavigation. Registration was based on cranial fiducials and image-guided surgery was performed with the navigation system.
Findings. Four of the 6 patients suffered from DAVF draining into the superior sagittal sinus, one fistula drained into paracavernous veins adjacent to the superior petrosal sinus and one patient had a pial fistula draining in the straight sinus. DAVF diagnosed with conventional angiography could be located on CE-MRA and MRA prior to surgery. MRI and MRA images were combined on the neuronavigation workstation and DAVF were located intraoperatively by using a tracking device. In 4 out of 6 cases neuronavigation was used for direct intraoperative identification of DAVF. Brain shift prevented direct tracking of pathological vessels in the other 2 cases, where navigation could only be used to assist craniotomy. Microsurgical dissection and coagulation of the fistulas led to complete cure in all patients as confirmed by angiography.
Conclusions. Neuronavigation may be used as an additional tool for microsurgical treatment of DAVF. However, in this small series of 6 cases, surgical procedures have not been substantially altered by the use of the neuronavigation system. Image guidance has been beneficial for the location of small, superficially located DAVF, whereas a navigated approach to deep-seated lesions was less accurate due to the familiar problem of brain shift and brain retraction during surgery.
Similar content being viewed by others
References
I Awad (2002) ArticleTitleCranial base approaches for the surgical treatment of aggressive posterior fossa dural arteriovenous fistulae with leptomeningeal drainage: a report of four technical cases. Neurosurgery 50 1160–1161
I Awad J Little W Akrawi J Ahl (1990) ArticleTitleIntracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72 839–850 Occurrence Handle1:STN:280:DyaK3c3ltVCksQ%3D%3D Occurrence Handle2140125
J Borden J Wu W Shucart (1995) ArticleTitleA proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82 166–179 Occurrence Handle1:STN:280:DyaK2M7hsVKrug%3D%3D Occurrence Handle7815143
V Coenen S Dammert M Reinges M Mull J Gilsbach V Rohde (2005) ArticleTitleImage-guided microneurosurgical management of small arteriovenous malformations: the value of navigated computed tomographic angiography. Neuroradiology 47 66–72 Occurrence Handle10.1007/s00234-004-1307-y Occurrence Handle1:STN:280:DC%2BD2M7pvVGitQ%3D%3D Occurrence Handle15645150
C Cognard Y Gobin L Pierot A Bailly E Houdart A Casasco J Chiras J Merland (1995) ArticleTitleCerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194 671–680 Occurrence Handle1:STN:280:DyaK2M7mslWjug%3D%3D Occurrence Handle7862961
S Coley C Romanowski T Hodgson P Griffiths (2002) ArticleTitleDural arteriovenous fistulae: noninvasive diagnosis with dynamic MR digital subtraction angiography. Am J Neuroradiol 23 404–407 Occurrence Handle11901008
M Collice G D’Aliberti O Arena C Solaini R Fontana G Talamonti (2000) ArticleTitleSurgical treatment of intracranial dural arteriovenous fistula: role of venous drainage. Neurosurgery 47 56–67 Occurrence Handle10.1097/00006123-200007000-00012 Occurrence Handle1:STN:280:DC%2BD3M%2FnsV2muw%3D%3D Occurrence Handle10917347
M Davies K ter Brugge R Willinsky M Wallace (1997) ArticleTitleThe natural history and management of intracranial dural arteriovenous fistulae: Part 1 – Benign lesions. Interv Neuroradiol 3 295–302
M Davies K ter Brugge R Willinsky M Wallace (1997) ArticleTitleThe natural history and management of intracranial dural arteriovenous fistulae: Part 2 – Aggressive lesions. Interv Neuroradiol 3 303–311
O Dudeck V van Velthoven M Schumacher J Klisch (2004) ArticleTitleDevelopment of a complex dural arteriovenous fistula next to a cerebellar developmental venous anomaly after resection of a brainstem cavernoma. J Neurosurg 100 335–339 Occurrence Handle15086243
R Gerlach H Yahya S Rohde M Bohm J Berkefeld I Scharrer V Seifert A Raabe (2003) ArticleTitleIncreased incidence of thrombophilic abnormalities in patients with cranial dural arteriovenous fistulae. Neurol Res 25 745–748 Occurrence Handle14579793
V Halbach D Roy J Raymond (1997) ArticleTitleThe role of transvenous embolization in the treatment of intracranial dural arteriovenous fistulas. Neurosurgery 40 1133–1141
B Hoh T Choudhri EJ Connolly R Solomon (1998) ArticleTitleSurgical management of high-grade intracranial dural arteriovenous fistulas: leptomeningeal venous disruption without nidus excision. Neurosurgery 42 796–805 Occurrence Handle1:STN:280:DyaK1c3jtlygsw%3D%3D Occurrence Handle9574644
K Irie M Kawanishi K Kunishio S Nagao (2001) ArticleTitleThe efficacy and safety of transvenous embolisation in the treatment of intracranial dural arteriovenous fistulas. J Clin Neurosci 8 92–96 Occurrence Handle10.1054/jocn.2001.0886 Occurrence Handle11386835
Y Kai J Hamada M Morioka K Koga S Hasegawa Y Ushio (2000) ArticleTitleCorrelation between magnetic resonance images and draining patterns in dural arteriovenous fistulas with leptomeningeal venous drainage. Acta Neurochir (Wien) 142 413–418 Occurrence Handle10.1007/s007010050451 Occurrence Handle1:STN:280:DC%2BD3M%2FgvVGitg%3D%3D
J Klisch H Huppertz U Spetzger A Hetzel W Seeger M Schumacher (2003) ArticleTitleTransvenous treatment of carotid cavernous and dural arteriovenous fistulae: results for 31 patients and review of the literature. Neurosurgery 53 836–856 Occurrence Handle14519216
J Klisch R Strecker R Hennig M Schumacher (2000) ArticleTitleTime-resolved projection MRA: clinical application in intracranial vascular malformations. Neuroradiology 42 104–107 Occurrence Handle1:STN:280:DC%2BD3c7jtVGitg%3D%3D Occurrence Handle10663484
J Kraus B Stuper J Muller H Nahser T Klockgether P Berlit U Harbrecht (2002) ArticleTitleMolecular analysis of thrombophilic risk factors in patients with dural arteriovenous fistulas. J Neurol 249 680–682 Occurrence Handle10.1007/s00415-002-0690-8 Occurrence Handle1:CAS:528:DC%2BD38XlvFWjurg%3D Occurrence Handle12111299
C Lucas J Zabramsk R Spetzler R Jacobowitz (1997) ArticleTitleTreatment of intracranial dural arteriovenous malformations. A meta-analysis from the English language literature. Neurosurgery 40 1119–1132 Occurrence Handle1:STN:280:DyaK2szitlCgtA%3D%3D Occurrence Handle9179884
A Muacevic H Steiger (1999) ArticleTitleComputer-assisted resection of cerebral arteriovenous malformations. Neurosurgery 45 1164–1170 Occurrence Handle10.1097/00006123-199911000-00030 Occurrence Handle1:STN:280:DC%2BD3c%2Fhs1WhtA%3D%3D Occurrence Handle10549933
S Nakajima H Atsumi AH Bhalerao FA Jolesz R Kikinis T Yoshimine TM Moriarty PE Stieg (1997) ArticleTitleComputer-assisted surgical planning for cerebrovascular neurosurgery. Neurosurgery 41 403–410 Occurrence Handle10.1097/00006123-199708000-00013 Occurrence Handle1:STN:280:DyaK2svgtFGnsA%3D%3D Occurrence Handle9257308
P Nelson S Russell H Woo A Alastra D Vidovich (2003) ArticleTitleUse of a wedged microcatheter for curative transarterial embolization of complex intracranial dural arteriovenous fistulas: indications, endovascular technique, and outcome in 21 patients. J Neurosurg 98 498–506 Occurrence Handle12650420
K Noguchi E Melhelm T Kanazawa M Kubo N Kuwayama H Seto (2004) ArticleTitleIntracranial dural arteriovenous fistulas: evaluation with combined 3D time-of-flight MR angiography and MR digital subtraction angiography. Am J Roentgenol 182 183–190
T Peters C Henri P Munger A Takahashi A Evans B Davey A Olivier (1994) ArticleTitleIntegration of stereoscopic DSA and 3D MRI for image-guided neurosurgery. Comput Med Imaging Graph 18 89–299 Occurrence Handle1:CAS:528:DyaK2MXltlCqsro%3D
J Rousseau D Gibon E Coste S Blond B Pertuzon B Coche C Vasseur X Marchandise (1994) ArticleTitleA frameless stereotaxic localisation system using MRI, CT and DSA. Acta Neurochir [Suppl] 64 40–44
S Russell H Woo S Joseffer J Jafar (2002) ArticleTitleRole of frameless stereotaxy in the surgical treatment of cerebral arteriovenous malformations: technique and outcomes in a controlled study of 44 consecutive patients. Neurosurgery 51 1108–1116 Occurrence Handle12383355
D Sarma K ter Brugge (2003) ArticleTitleManagement of intracranial dural arteriovenous shunts in adults. Eur J Radiol 46 206–220 Occurrence Handle10.1016/S0720-048X(03)00092-5 Occurrence Handle12758115
V Singh P Meyers V Halbach D Gress R Higashida C Dowd W Smith (2001) ArticleTitleDural arteriovenous fistula associated with prothrombin gene mutation. J Neuroimaging 11 319–321 Occurrence Handle1:STN:280:DC%2BD3MvhtlGjuw%3D%3D Occurrence Handle11462303 Occurrence Handle10.1111/j.1552-6569.2001.tb00055.x
M Sisti R Solomon B Stein (1991) ArticleTitleStereotactic craniotomy and resection of small arteriovenous malformations. J Neurosurg 75 40–44 Occurrence Handle1:STN:280:DyaK3M3lvFanuw%3D%3D Occurrence Handle2045916
B Thompson J Doppmann E Oldfield (1994) ArticleTitleTreatment of cranial dural arteriovenous fistulae by interruption of leptomeningeal venous drainage. J Neurosurg 80 617–623 Occurrence Handle1:STN:280:DyaK2c3gtFyhtA%3D%3D Occurrence Handle8151339
W Tirakotai U Sure L Benes B Krischek S Bien H Bertalanffy (2003) ArticleTitleImage-guided transsylvian, transinsular approach for insular cavernous angiomas. Neurosurgery 53 1299–1304 Occurrence Handle14633296
P Tomak H Cloft A Kaga C Cawley J Dion D Barrow (2003) ArticleTitleEvolution of the management of tentorial dural arteriovenous malformations. Neurosurgery 52 750–760 Occurrence Handle12657170
R Uranishi H Nakase T Sakaki (1999) ArticleTitleExpression of angiogenic growth factors in dural arteriovenous fistula. J Neurosurg 91 781–786 Occurrence Handle1:STN:280:DC%2BD3c%2Fgslanug%3D%3D Occurrence Handle10541235
S Wetzel D Bilecen P Lyrer G Bongartz E Seifritz E Radue K Scheffler (2000) ArticleTitleCerebral dural arteriovenous fistulas: detection by dynamic MR projection angiography. AJR Am J Roentgenol 174 1293–1295 Occurrence Handle1:STN:280:DC%2BD3c3kvVKnsA%3D%3D Occurrence Handle10789780
L Zamorano M Planells Z Jiang L Nolte A Kadi F Diaz (1996) ArticleTitleVascular malformations of the brain: surgical management using interactive image guidance. Neurosurg Clin N Am 7 201–214 Occurrence Handle1:STN:280:DyaK283pvVGhsQ%3D%3D Occurrence Handle8726436
Author information
Authors and Affiliations
Additional information
Both authors equally contributed to this work.
Rights and permissions
About this article
Cite this article
Vougioukas, V., Coulin, C., Shah, M. et al. Benefits and limitations of image guidance in the surgical treatment of intracranial dural arteriovenous fistulas. Acta Neurochir (Wien) 148, 145–153 (2006). https://doi.org/10.1007/s00701-005-0656-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-005-0656-6