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Updated: Jun 16, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Intracranial dural arteriovenous fistula successfully treated by combined open-endovascular procedure
Giorgio G Hallaert1, Katrien M De Keukeleire, Dimitri J Vanhauwaert
1Department of Neurosurgery-4K12 IE, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. giorgiohallaert@yahoo.com
Insights
Intracranial dural arteriovenous fistulas are rare but dangerous. A combined neurosurgical and endovascular approach using transarterial ONYX embolisation effectively obliterates these fistulas, improving patient outcomes.
Area of Science:
- Neurosurgery
- Interventional Radiology
- Vascular Neurology
Background:
- Intracranial dural arteriovenous fistulas (dAVFs) are rare vascular malformations with a high risk of hemorrhage and neurological deficit due to direct high-pressure arterial to low-pressure venous shunting.
- Borden and Cognard classifications correlate bleeding risk with fistula venous drainage patterns, guiding treatment strategies.
- Optimal treatment for dAVFs remains challenging, necessitating individualized approaches.
Observation:
- This case report details a challenging dAVF case requiring multidisciplinary management.
- The study highlights the successful collaboration between neurosurgical and endovascular teams.
- A novel endovascular technique involving transarterial ONYX embolisation was employed.
Findings:
- Complete obliteration of the intracranial dural arteriovenous fistula was achieved.
- The combined neurosurgical and endovascular approach demonstrated significant benefit to patient outcome.
- Transarterial ONYX embolisation proved effective in treating this complex vascular malformation.
Implications:
- This case supports the growing evidence for the efficacy of transarterial ONYX embolisation in treating dAVFs.
- Multidisciplinary collaboration between neurosurgery and interventional radiology enhances treatment success for complex vascular lesions.
- The findings contribute to optimizing management strategies for intracranial dAVFs, potentially reducing morbidity and mortality.
Abstract:
Intracranial dural arteriovenous fistulas constitute a rare though potentially devastating disease. Because the arterial (high-pressure) blood flow drains directly into the low-pressure venous system, there is a high risk of bleeding and associated neurological deficit. The classifications by Borden and Cognard underline the correlation between bleeding risk and venous drainage pattern of the fistula. There are different treatment options for this vascular pathology, which always poses a challenge for the physicians involved to offer the optimal treatment for an individual patient. This case report illustrates how combining forces between the neurosurgical and endovascular team benefits outcome. Simultaneously, this contributes to the growing amount of evidence that a new endovascular technique with transarterial ONYX embolisation enables complete obliteration of the vascular malformation.