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Abstract
This study evaluated the clinical outcomes following venous ligation for the treatment of dural arteriovenous fistulas (DAVF) with leptomeningeal or cortical venous drainage. The authors conducted a single-centre, retrospective study of 15 patients with DAVF treated consecutively between 1990 and 2000. There were eight female patients of mean age 60 years (range 36 - 71). Eight patients presented with haemorrhage, two with mass affect, two with headaches, one with seizures and two patients were asymptomatic. Four fistulas were located in the petrosal region, three at the torcula, three in the transverse sigmoid region, three in the parasagittal region and two at the foramen magnum. Leptomeningeal or cortical veins drained all DAVF. Eight patients underwent preoperative embolization of the arterial feeders. Venous ligation resulted in obliteration of all fistula confirmed by direct visualization of the thrombosed veins and/or radiographic follow up. Mean follow up period was 37 months with a range of 1 - 112 months. All symptomatic patients improved and there was no surgical morbidity. These results indicated that venous ligation to obliterate DAVF with leptomeningeal or cortical drainage is safe and effective. With appropriate neuroradiological diagnosis and preoperative neuroendovascular intervention, this technique resulted in obliteration of DAVF in 15 patients without significant morbidity.