Microsurgical Management of Galenic Dural Arteriovenous Fistula: 3-Dimensional Operative Video

Microsurgical Management of Galenic Dural Arteriovenous Fistula: 3-Dimensional Operative Video SURGICAL VIDEO Microsurgical Management of Galenic Dural Arteriovenous Fistula: 3-Dimensional Operative Video Arnau Benet, MD,* Michael T. Lawton, MD*‡ *Department of Neurosurgery, University of California, San Francisco, San Francisco, California; ‡Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, California Watch now at http://bit.ly/1MKxdL7 This video demonstrates the microsurgical management of a galenic dural arteriovenous fistula (DAVF). This 37-year-old woman presented with severe headaches, and evaluation with magnetic The 3-D video can be viewed at http://bit.ly/1MKxdL7 resonance imaging demonstrated an incidental vascular malforma- tion in the quadrigeminal cistern. Catheter angiography revealed Disclosure a galenic DAVF supplied bilaterally by tentorial and meningeal The authors have no personal, financial, or institutional interest in any of the drugs, arteries, as well as branches of posterior cerebral and superior materials, or devices described in this article. cerebellar arteries (arteries of Davidoff and Schechter). The deep venous system no longer drained through the vein of Galen or straight sinus and used anterior collaterals instead. The DAVF was COMMENT aggressively embolized transarterially, but numerous feeders pre- vented curative obliteration, and tortuous draining veins prevented alenic dural arteriovenous fistulas are a rare and complex pathology transvenous access. A torcular craniotomy and posterior interhemi- G with a devastating natural history. Dr Lawton’s experience with spheric approach were performed to occlude the fistula. The patient surgical management of these lesions is highlighted by impressive ra- diographic results and clinical outcomes. This operative video demon- was positioned laterally to allow gravity to retract the right occipital strating mobilization of the falcotentorial junction and isolation of the lobe. Transecting the falx and tentorium bilaterally skeletonized the venous drainage of this challenging lesion is a meaningful adjunct to his straight sinus, which visualized the posterior cerebral and superior series of tentorial dural arteriovenous fistulas and is of great educational cerebellar artery feeders and the dilated draining galenic veins. value to vascular neurosurgery. Right-angle fenestrated clips were applied in tandem to close the vein of Galen, thereby occluding the fistula on the venous side. Indocyanine green angiography was used to identify and then Daniel M. Heiferman occlude additional venous outflow. Postoperative angiogram con- Christopher M. Loftus firmed occlusion of the DAVF, and the patient recovered with no Maywood, Illinois neurological deficits at 4 months. This case illustrates galenic DAVFs and the posterior interhemispheric approach to this region. The benefits of gravity retraction, falcotentorial transection, and 1. Lawton MT, Sanchez-Mejia RO, Pham D, et al. Tentorial dural arteriovenous indocyanine green angiography are demonstrated. After the venous fistulas: operative strategies and microsurgical results for six types. Neurosurgery. outflow is interrupted, the fistulous pathology can remain in situ. 2008;62(3 suppl 1):110-124. OPERATIVE NEUROSURGERY VOLUME 12 | NUMBER 4 | DECEMBER 2016 | 391 Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Operative Neurosurgery Oxford University Press

Microsurgical Management of Galenic Dural Arteriovenous Fistula: 3-Dimensional Operative Video

Free
1 page

Loading next page...
1 Page
 
/lp/ou_press/microsurgical-management-of-galenic-dural-arteriovenous-fistula-3-GNcoM7dx5B
Publisher
Congress of Neurological Surgeons
Copyright
Copyright © 2015 by the Congress of Neurological Surgeons
ISSN
2332-4252
eISSN
2332-4260
D.O.I.
10.1227/NEU.0000000000001142
Publisher site
See Article on Publisher Site

Abstract

SURGICAL VIDEO Microsurgical Management of Galenic Dural Arteriovenous Fistula: 3-Dimensional Operative Video Arnau Benet, MD,* Michael T. Lawton, MD*‡ *Department of Neurosurgery, University of California, San Francisco, San Francisco, California; ‡Center for Cerebrovascular Research, University of California, San Francisco, San Francisco, California Watch now at http://bit.ly/1MKxdL7 This video demonstrates the microsurgical management of a galenic dural arteriovenous fistula (DAVF). This 37-year-old woman presented with severe headaches, and evaluation with magnetic The 3-D video can be viewed at http://bit.ly/1MKxdL7 resonance imaging demonstrated an incidental vascular malforma- tion in the quadrigeminal cistern. Catheter angiography revealed Disclosure a galenic DAVF supplied bilaterally by tentorial and meningeal The authors have no personal, financial, or institutional interest in any of the drugs, arteries, as well as branches of posterior cerebral and superior materials, or devices described in this article. cerebellar arteries (arteries of Davidoff and Schechter). The deep venous system no longer drained through the vein of Galen or straight sinus and used anterior collaterals instead. The DAVF was COMMENT aggressively embolized transarterially, but numerous feeders pre- vented curative obliteration, and tortuous draining veins prevented alenic dural arteriovenous fistulas are a rare and complex pathology transvenous access. A torcular craniotomy and posterior interhemi- G with a devastating natural history. Dr Lawton’s experience with spheric approach were performed to occlude the fistula. The patient surgical management of these lesions is highlighted by impressive ra- diographic results and clinical outcomes. This operative video demon- was positioned laterally to allow gravity to retract the right occipital strating mobilization of the falcotentorial junction and isolation of the lobe. Transecting the falx and tentorium bilaterally skeletonized the venous drainage of this challenging lesion is a meaningful adjunct to his straight sinus, which visualized the posterior cerebral and superior series of tentorial dural arteriovenous fistulas and is of great educational cerebellar artery feeders and the dilated draining galenic veins. value to vascular neurosurgery. Right-angle fenestrated clips were applied in tandem to close the vein of Galen, thereby occluding the fistula on the venous side. Indocyanine green angiography was used to identify and then Daniel M. Heiferman occlude additional venous outflow. Postoperative angiogram con- Christopher M. Loftus firmed occlusion of the DAVF, and the patient recovered with no Maywood, Illinois neurological deficits at 4 months. This case illustrates galenic DAVFs and the posterior interhemispheric approach to this region. The benefits of gravity retraction, falcotentorial transection, and 1. Lawton MT, Sanchez-Mejia RO, Pham D, et al. Tentorial dural arteriovenous indocyanine green angiography are demonstrated. After the venous fistulas: operative strategies and microsurgical results for six types. Neurosurgery. outflow is interrupted, the fistulous pathology can remain in situ. 2008;62(3 suppl 1):110-124. OPERATIVE NEUROSURGERY VOLUME 12 | NUMBER 4 | DECEMBER 2016 | 391 Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.

Journal

Operative NeurosurgeryOxford University Press

Published: Dec 1, 2016

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 12 million articles from more than
10,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Unlimited reading

Read as many articles as you need. Full articles with original layout, charts and figures. Read online, from anywhere.

Stay up to date

Keep up with your field with Personalized Recommendations and Follow Journals to get automatic updates.

Organize your research

It’s easy to organize your research with our built-in tools.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve Freelancer

DeepDyve Pro

Price
FREE
$49/month

$360/year
Save searches from
Google Scholar,
PubMed
Create lists to
organize your research
Export lists, citations
Read DeepDyve articles
Abstract access only
Unlimited access to over
18 million full-text articles
Print
20 pages/month
PDF Discount
20% off