Novel Hybrid Treatment Approach for Dural Arteriovenous Fistula with Isolated Sinus and Absent Direct Dural Feeders

Abstract

Introduction: Dural arteriovenous fistula (AVF) may present with varied imaging presentation. Hybrid treatment approches which include surery and endovascular techniques are beneficial for isoloated sinus in dural AVF. Methods: We present two case scenarios of complex cerebral dural AVFs. Both the patients had similar appearances on imaging which mimicked hemorrhage and tumor. With likely suspicion of fistula, digital subtraction angiography was initially performed, which confirmed the diagnosis. We chose to adopt a hybrid technique to treat them using the neurosurgical suite. Burr-hole craniotomy procedure followed by the direct embolization of the fistula was offered to both patients. Results: Fistulae were completely cured with the minimal duration of hospital stay. Follow-up showed the complete resolution of their symptoms. Conclusion: Treating complex cerebral dural AVFs is as challenging as diagnosing them on cross-sectional imaging and may require a combined approach.