[Hybrid surgery for complex symptomatic intracranial fistulas: a technical note]

Area of Science:

• Neurosurgery
• Interventional Neurology
• Vascular Surgery

Background:

• Complex intracranial fistulas, including dural arteriovenous fistulas (dAVFs) and carotid cavernous fistulas (CCFs), pose significant management challenges.
• Traditional treatment modalities may have limitations in achieving complete occlusion and preventing recurrence.

Purpose of the Study:

• To evaluate the efficacy and safety of hybrid surgical management for complex symptomatic intracranial fistulas.
• To assess the outcomes of a hybrid approach combining endovascular techniques and open surgery in a neurovascular hybrid operating room.

Main Methods:

• A retrospective analysis of 3 patients with complex intracranial fistulas (2 dAVFs, 1 CCF) treated between March 2014 and January 2015.
• Hybrid surgery was employed after initial endovascular treatment failure, involving meningeal artery embolization followed by craniotomy for dAVFs, and direct cavernous sinus puncture after craniotomy for CCF.

Main Results:

• Successful complete occlusion was achieved in 2 patients and near-complete occlusion in 1 patient post-operatively.
• No immediate complications were reported. Patients showed significant symptom improvement or resolution at discharge.
• One patient experienced recurrence at 21 months, successfully treated with re-embolization.

Conclusions:

• Hybrid surgery represents a viable and promising therapeutic option for complex intracranial fistulas, particularly when endovascular approaches are insufficient.
• The hybrid strategy facilitates tailored treatment, potentially improving outcomes and reducing complications in challenging neurovascular cases.