Artikel
Surgical management of dural arteriovenous fistulas (DAVFs) with feeding arteries involving the occipital condyle and the jugular foramen
Das chirurgische Management von duralen arteriovenösen Fisteln (DAVFs) mit arteriellen Zuflüssen, die den Condylus occipitalis und das Foramen jugulare einbeziehen
Suche in Medline nach
Autoren
Veröffentlicht: | 8. Mai 2006 |
---|
Gliederung
Text
Objective: Dural arteriovenous fistulas (DAVFs), partially with feeding arteries located in bony structures around the occipital condyle and the jugular foramen are complex vascular malformations and belong to the most challenging skull base lesions to treat. A consecutive series of patients with multiple features in a series of DAVFs involving bony structures around the foramen magnum were comprehensively evaluated.
Methods: Four consecutive patients were treated microsurgically via the far lateral approach for DAVFs with osseus feeders around the occipital condyle and the jugular foramen in our department. The charts and videos of these individuals were reviewed retrospectively to analyze surgical strategies in the management of these complex vascular lesions. Obliteration of the DAVFs were postoperatively confirmed by angiography in all patients.
Results: Complete obliteration of the dural arteriovenous fistulas (DAVFs) was achieved in three and significant flow reduction in one individual. All patients had good outcomes (Glasgow outcome scale 4 or 5). One individual experienced treatment-associated mild hypoglossal nerve palsy. The treatment mortality rate was zero. As a consequence of extensive bilateral drilling of the occipital condyle, an occipito-cervical fusion was necessary in one patient with a lesions involving both condyles.
Conclusions: For a total occlusion in DAVFs partially supplied by arteries within bony structures around the foramen magnum, the far lateral approach should be considered an elegant armamentarium that improves the occlusion-rate of this challenging vascular lesions most effectively.