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Chirurgia 2013 February;26(1):5-11

language: English

Incidentally detected dural arteriovenous fistulas in the anterior cranial fossa: report of four cases and review of literature

Takeda N. 1, Tatsumi S. 1, Nishihara M. 1, Kidoguchi K. 1, Kohmura E. 2

1 Department of Neurosurgery,, Nishi-Kobe Medical Center, Kobe city, Japan;
2 Department of Neurosurgery. Kobe University Graduate School of Medicine, Kobe city, Japan


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Aim: Dural arteriovenous fistulas (DAVFs) in the anterior cranial fossa are very rare, but reports of these lesions have been increasing recently due to the development of magnetic resonace imaging (MRI). The aim of this article was to study the frequency, treatment modalities and outcomes of DAVFs in the anterior cranial fossa before and after the introduction of MRI and analyszes the predictive factors for hemorrhage.
Methods: We summarized the characteristics of clinical features, neuroimaging, treatment modalities and outcomes of 154 reported anterior cranial fossa DAVFs, including our four cases.
Results: Most cases present intracranial hemorrhage, accounting for 55.1% (85 hemorrhagic cases of 154 cases). However, reports of non-hemorrhagic cases (especially incidental cases) have been increasing after introduction of MRI. Reported non-hemorrhagic cases comprised 5 of 34 cases (14.7%) before 1990, but 64 of 120 cases (53.3%) after 1990. The frequency of varices was significantly different between hemorrhagic cases (78.9%) and incidental cases (53.8%) (p=0.005, Fisher exact test). DAVFs accompanied by varices were liable to bleed. Craniotomy was yet a choice of treatment for DAVFs in the anterior cranial fossa but recently successful occlusion of lesions by transarterial and transvenous embolization was reported.
Conclusion: We emphasize the increase in incidentally detected cases and the need for surgical obliteration of fistulae of incidental detected dural AVF with varices.

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