Combined surgical and endovascular treatment of high-risk intracranial dural arteriovenous fistulas.

We evaluated the efficacy of combined surgical and endovascular treatment of high-risk dural arteriovenous fistulas (AVFs) with retrograde leptomeningeal venous drainage. Of 92 patients with intracranial dural AVF, 14 underwent combined surgical and endovascular treatment. Dural AVF was located in the cavernous sinus in two, the petrotentorial region in one, and the transverse-sigmoid sinus in 11. Characteristic features of the patients were retrograde leptomeningeal venous drainage and obstruction of transvenous access routes. All the patients were treated with combined transarterial embolisation and surgical procedures including craniotomy and sinus packing with coils, or clipping of the draining vein. Dural AVF was completely obliterated in all patients without obvious neurologic complications. In the mean follow-up period of 4.2 years, a new dural AVF on the cortex adjacent to the treated sinus developed in one patient. Combined surgical and endovascular treatment is effective for the treatment of high-risk dural AVFs.