INTRACRANIAL DURAL ARTERIOVENOUS-FISTULAS WITH PIAL VENOUS DRAINAGE -COMBINED ENDOVASCULAR - NEUROSURGICAL THERAPY

Background: Intracranial dural arteriovenous fistula with pial venous drainage may present with hemorrhage or focal neurologic deficit and m ay be difficult to treat. We wish to summarize the therapeutic approac hes to these potentially dangerous lesions and to demonstrate how endo vascular and neurosurgical therapies may have complimentary roles in t heir management. Methods. The clinical and radiological records of all patients who presented to our institution with intracranial dural art eriovenous fistula over the last 5 years were reviewed. In those cases demonstrating pial venous drainage, details of presentation, imaging features, endovascular and surgical therapy and outcome were analyzed. Results. We identified 13 patients with these lesions, 7 of whom pres ented with intracranial hemorrhage. Six patients were treated with emb olization alone, Angiographic cure was achieved in 4. There was one co mplication in this group, a subarachnoid hemorrhage following glue inj ection, Four patients were treated with embolization followed by surgi cal occlusion of the pial venous drainage, Angiographic curl was achie ved in all 4. There was one complication in this group, a facial nerve palsy following glue injection, Three patients were treated by surger y alone, with no complications and complete cure in all, Conclusion: E ndovascular therapy of intracranial dural arteriovenous fistula. may b e curative but is often complex and carries definite risks, Neurosurgi cal ligation of pial draining veins, with pra-operative embolization w hen safe, may be a relatively more controlled method to achieve comple te cure.