Surgical Treatment of Dural Arteriovenous Fistula: A Case Report and Literature Review

Dural arteriovenous fistulas (dAVF) are rare, acquired intracranial arteriovenous malformations consisting of a pathological shunt located within the intracranial dura matter. The etiology of dAVFs remains unclear, but current thought suggests that these lesions are associated with thrombosis of the dural sinuses and other intracranial veins. dAVF's with severe symptomatology or high-risk angioarchitecture should be treated without delay, and endovascular repair is generally accepted as the first-line treatment. Both transarterial and transvenous approaches can be used to cure dAVFs. Surgery and stereotactic radiosurgery may also be used when endovascular approaches are unsuccessful or not feasible. Some studies, however, have shown that surgery for dAVFs in the anterior cranial fossa is preferred over the endovascular approach. Due to the proximity of some dAVFs to the orbit, endovascular embolization of the dAVF carries a higher risk of complications, primarily due to the formation of dangerous extracranial or intracranial anastomoses. We present the case of a 64-year-old male with an incidentally discovered Borden type III dAVF arising from the anterior branches of the middle meningeal artery and draining into the middle cerebral vein. Due to the location of his dAVF, craniotomy was selected for ligation of the fistula. The procedure went without complication. A catheter angiogram of the brain one month after surgery showed an absence of flow through the arteriovenous fistula and a middle meningeal artery that had returned to its normal caliber.