Surgical Disconnection of the Cortical Venous Reflux for High-Grade Intracranial Dural Arteriovenous Fistulas

Objectives To assess the clinical outcome, complications, and angiographic outcomes after surgical disconnection of intracranial dural arteriovenous fistulas (DAVFs). Methods Analysis of prospectively collected data, including clinical presentation, preoperative angiographic findings, postoperative complications, clinical, and angiographic outcomes. Results Between January 2002 and January 2012, 25 patients underwent surgery for DAVFs. The anatomical locations included tentorial (8), ethmoidal (8), foramen magnum (5), middle fossa (2), torcular (1), and parafalcine (1). All had cortical venous reflux (CVR) and all were treated with craniotomy and disconnection of CVR. Two patients required repeat surgery for residual CVR. One patient had a postoperative seizure. There were no other complications. All patients had complete disconnection of CVR confirmed by digital subtraction angiography. None of the patients have had hemorrhage or recurrence of CVR on follow-up. Conclusions Surgical disconnection of CVR for high-grade intracranial DAVFs is highly effective and can be performed with very low complication rates. Where embolization cannot be performed safely, surgical disconnection (rather than stereotactic radiosurgery) is the treatment of choice for high grade DAVFs.