[Long-term efficacies of sinus skeletonization plus abnormal venous reflux interruption in the treatment of parasinus dural arteriovenous fistula].

ABSTRACT

OBJECTIVE: To retrospectively explore the long-term efficacies of sinus skeletonization plus abnormal venous reflux interruption in the treatment of dural arteriovenous fistula interfering major dural sinus. METHODS: Among 15 consecutively treated patients, the lesions were located in superior sagittal sinus (n = 7), medial segment of transverse sinus (n = 3) and lateral transverse and sigmoid sinus (n = 5). And 40% of them clinically presented with intracranial hypertension and 13.3% with hemorrhage. Preoperatively, Gamma knife therapy and transarterial occlusion were used in 1 case each. All underwent sinus skeletonization plus abnormal venous reflux interruption if any. Interfered sinus was preserved in 12 cases. In another 3 cases, completely occluded segment of sinus was resected after skeletonization. RESULTS: Surgical mortality was none. At discharge, the symptoms were relieved or disappeared in 12 cases. Follow-up study was available in 11 cases over a mean period of 6 years. A Karnofsky performance status (KPS) score of 90 or more was achieved in 8 cases and a KPS score of 80, 60 or 40 was found in 1 case each. Digital subtract angiography was performed in 9 cases and computed tomographic angiography in 1 case after operation. Cure was achieved in 7 cases and 3 cases had minimal residue without recurrence. CONCLUSION: Sinus skeletonization may stably block most blood supply to fistula so as to offer cure or long-term control of dural arteriovenous fistula.