Mini-pterional approach for clip ligation of ethmoidal dural arteriovenous fistula

Neurosurg Focus. 2019 Apr 1;46(Suppl_2):V9. doi: 10.3171/2019.2.FocusVid.18660.

Abstract

Ethmoidal dural arteriovenous fistulas (DAVFs) have a near-universal association with cortical venous drainage and a malignant clinical course. Endovascular treatment options are often limited due to the high frequency of ophthalmic artery ethmoidal supply. A 64-year-old gentleman presented with syncope and was found to have a right ethmoidal DAVF. Rather than the traditional bicoronal craniotomy, an endoscope-assisted mini-pterional approach for clip ligation is demonstrated. The mini-pterional craniotomy allows a minimally invasive approach to ethmoidal DAVF via a lateral trajectory. The endoscope can help achieve full visualization in the narrow corridor.The video can be found here: https://youtu.be/ZroXp-T35DI.

Keywords: bicoronal; dural arteriovenous fistula; ethmoidal; mini-pterional; video.

Publication types

  • Case Reports

MeSH terms

  • Central Nervous System Vascular Malformations / diagnosis
  • Central Nervous System Vascular Malformations / surgery*
  • Cranial Fossa, Anterior / surgery*
  • Craniotomy / methods
  • Embolization, Therapeutic*
  • Humans
  • Ligation / methods
  • Male
  • Middle Aged
  • Surgical Instruments