Surgical management of dural arteriovenous malformations of the cranium

Ten patients undergoing surgical treatment of dural arteriovenous malformations of the cranium between June 1992 and June 1995 are presented. Indications for surgery were prevention of intracranial haemorrhage in eight cases and palliation of neurological deficits in two cases. The aim of surgery was attempted complete cure when considered technically feasible. Six patients underwent aggressive surgical resection in an ablation attempt and four underwent leptomeningeal venous disconnection only. In those undergoing aggressive surgical resection, one patient died, one was rendered disabled and angiographic cure was achieved in four without mishap. In those undergoing leptomeningeal venous disconnection, there was no mortality or morbidity but angiographic cure was achieved in only one of four patients. As a result of our experience our policy has changed. When the indications for surgery are to palliate leptomeningeal venous hypertension or as prophylaxis against future haemorrhage, interruption of the involved leptomeningeal venous drainage in the subarachnoid space without attempted cure is now the sole aim of surgery. The surgical technique employed should be based on the pathophysiological disturbance requiring correction rather than the resectability of the lesion.