Surgical management of dural arteriovenous, malformations of the cranium

Ten patients undergoing surgical treatment of dural arteriovenous malformat ions of the cranium between June 1992 and June 1995 are presented, Indicati ons for surgery Were prevention of intracranial haemorrhage in eight cases and palliation of neurological deficits in two eases. The aim of surgery wa s attempted complete cure when considered technically feasible. Six patient s underwent aggressive surgical resection in an ablation attempt and four u nderwent leptomeningeal venous disconnection only. In those undergoing aggr essive surgical resection, one patient died, one was rendered disabled and angiographic cure was achieved in four without mishap. In those undergoing leptomeningeal venous disconnection, there was no mortality or morbidity bu t angiographic cure was achieved in only one of four patients. ihs a result of our experience our policy has changed. When the indications for surgery are to palliate leptomeningeal venous hypertension or as prophylaxis again st future haemorrhage, interruption of the involved leptomeningeal venous d rainage in the subarachnoid space without attempted cure is now the sole ai m of surgery. The surgical technique employed should be base on the pathoph ysiological disturbance requiring correction rather than the resectability of the lesion.