PT  - JOURNAL ARTICLE
AU  - Shih-Chieh Shen
AU  - Yuang-Seng Tsuei
AU  - Wen-Hsien Chen
AU  - Chiung-Chyi Shen
TI  - Hybrid surgery for dural arteriovenous fistula in the neurosurgical hybrid operating suite
AID  - 10.1136/neurintsurg-2013-011060.rep
DP  - 2015 Feb 01
TA  - Journal of NeuroInterventional Surgery
PG  - e6--e6
VI  - 7
IP  - 2
4099  - http://jnis.bmj.com/content/7/2/e6.short
4100  - http://jnis.bmj.com/content/7/2/e6.full
SO  - J NeuroIntervent Surg2015 Feb 01; 7
AB  - 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.