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Case report
Hybrid surgery for dural arteriovenous fistula in the neurosurgical hybrid operating suite
  1. Shih-Chieh Shen1,2,
  2. Yuang-Seng Tsuei2,3,
  3. Wen-Hsien Chen4,
  4. Chiung-Chyi Shen2,3
  1. 1Department of Neurosurgery, Triservice General Hospital Songshan Branch, Taiwan
  2. 2Department of Neurosurgery, Taichung Veterans General Hospital, Taiwan
  3. 3Department of Neurosurgery, Triservice General Hospital, National Defense Medical Center, Taiwan
  4. 4Department of Neuroradiology, Taichung Veterans General Hospital, Taiwan
  1. Correspondence to Dr Yuang-Seng Tsuei, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan; astrocytoma2001{at}


Treatment of a dural arteriovenous fistula (AVF), which is difficult to access by either the surgical or endovascular approach, is challenging. A hybrid technique, combining a microsurgical approach and endovascular embolization, can provide less invasive management of dural AVFs in a modern neurosurgical hybrid operating suite. We present a case of intracerebral hemorrhage in the left cerebellum secondary to dural AVF, Cognard type IV with numerous tiny feeders from the ascending pharyngeal artery branches. No adequate arterial or venous route for endovascular embolization was found by neuroangiography. The hybrid technique, combining keyhole pterional craniotomy and embolization with n-butyl cyanoacrylate glue injection via direct cannulation of the periclival venous plexus, succeeded in obliterating the dural AVF. Intraoperative angiography showed successful embolization of the dural AVF without any complication. This report illustrates the usefulness of the neurosurgical hybrid operating suite for the treatment of difficult dural AVFs.

  • Technique
  • Intervention
  • Fistula
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