MICROSURGICAL INTERHEMISPHERIC APPROACH TO DURAL ARTERIOVENOUS-FISTULAS OF THE FLOOR OF THE ANTERIOR CRANIAL FOSSA

Six patients with a dural arteriovenous fistula (DAVF) of the floor of the anterior cranial fossa underwent microsurgical treatment. Two of them were operated using a conventional frontobasal approach, and four using an interhemispheric approach. The interhemispheric approach off ers the advantages of sparing the frontal sinus, minimizing frontal lo be retraction, and providing a visual angle perpendicular to the floor of the anterior fossa and an excellent view of the fistula located on the cribriform plate at the level of the foramen caecum. Using the in terhemispheric route, the malformation was occluded in all the cases b y dividing the vascular connection between the dura of the cribriform plate and the intradural draining vein. There were no complications re lated to the surgical procedure. This route avoids some disadvantages of the more frequently reported frontobasal approach, It is therefore a recommendable alternative for the management of frontal DAVFs.