Technical Trick of Combined Embolization of Inaccessible Dural Arteriovenous Fistula by Endovascular Route Only

Abstract

Endovascular embolization of dural arteriovenous fistula may not be a feasible approach depending on the location and/or surrounding structures. Combined embolization comprising endovascular embolization by direct puncture of the sinus after small craniotomy under fluoroscopic guidance is a good treatment option for lesions that cannot be treated by endovascular embolization alone. We presented 2 cases of dural arteriovenous fistula that could not be treated by endovascular embolization alone. Treatment included direct puncture of the sinus after small craniotomy to access and completely block the lesion. Combined techniques are required for the management of complex dural arteriovenous fistula. We report a treatment method that can be used for lesions that cannot be treated by endovascular embolization alone along with some technical pitfalls.