Related Experiment Video
Updated: Aug 16, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Multidisciplinary management of posterior fossa dural arteriovenous fistula: A single-center experience
J Tinois1, G Danassegarane2, M Bretonnier3
1Pôle des neurosciences, service de neurochirurgie, centre hospitalier universitaire de Rennes, Rennes, France; Faculté de médecine, université de Rennes 1, Rennes, France; Inserm UMR 1099 LTSI, laboratoire du traitement de signal, unité médicis, université de Rennes 1, Rennes, France.
Purpose:
The management of posterior fossa dural arteriovenous fistulas (pfDAVFs) is challenging. Here, we show how multidisciplinarity leads to their successful management, even in complex cases.
Methods:
All pfDAVFs managed from 2010 to 2019 at our center were reviewed. The preoperative clinical and radiological characteristics, their management and the occlusion rate were retrieved. The radiological and functional outcomes were retrieved at discharge and last follow-up (FU).
Results:
n=27 patients were included (6 females, mean age: 61-years-old, mean FU: 22.5 months). n=8 patients presented with cerebral hemorrhage. Among patients with ruptured pfDAVFs, n=7 had headache, n=4 had ataxia, and n=2 had impaired level of consciousness. In the unruptured group N (n=19), n=7 patients had headache, n=6 patients had focal neurological deficit, n=4 patients had tinnitus, n=3 (had ataxia, and one presented with seizure. n=24 patients were treated by endovascular therapy (EVT), n=2 patients were treated by microsurgery (MS) and n=1 patient was managed with a combined approach. Re-treatment was necessary in n=6 patients. n=24 patients showed total exclusion at last FU. n=2 patients died during the first 30 days; n=1 patient died during FU.
Conclusions:
While EVT should be advocated as the first line therapy whenever possible, MS should not be banned from the treatment armamentarium. Neurosurgeons must be able to achieve direct surgical occlusion when the angioarchitecture speaks against EVT.
