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Updated: Mar 2, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
How I do it: surgical ligation of craniocervical junction dural AV fistulas
Thomas J Sorenson1, Biagia La Pira2, Joshua Hughes2
1Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA. tsorenson@wisc.edu.
Background:
Dural arteriovenous fistulas (DAVFs) of the craniocervical junction are uncommon vascular lesions, which often require surgical treatment even in the endovascular era.
Methods:
Most commonly, the fistula is placed laterally, and surgical ligation is performed through a lateral suboccipital craniotomy. After dural opening, the area is inspected, and the arterialized vein is identified emerging from the dura, often adjacent to the entry point of the vertebral artery, and ligated.
Conclusions:
A far lateral craniotomy is the authors' preferred surgical approach for accessing and treating dural arteriovenous fistulas of the craniocervical junction that cannot be reached endovascularly.
