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Anterior interhemispheric approach for anterior fossa dural arteriovenous fistulas

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Abstract

Anterior fossa dural arteriovenous fistulas (AF-DAVF) usually display a cortical venous drainage and are therefore at risk for rupture. Microsurgery is traditionally considered in many centers as the first-line treatment since endovascular treatment (EVT) entails a lower cure rate and significant ophthalmic risks. The anterior interhemispheric approach (AIA), originally described by Mayfrank in 1996, seems to offer the effectiveness of microsurgery while limiting the risks related to subfrontal craniotomy. The objective of this study was to analyze the surgical outcomes of patients who underwent this surgical approach for the treatment of AF-DAVF. We hereby describe our 10 years’ experience of patients treated for an AF-DAVF with this technique in our institution and retrospectively analyzed our results. In addition, we describe our operative technique and its specificities. Eleven patients with AF-DAVF were included in our study. The definitive cure of the fistula was confirmed in all cases with postoperative cerebral angiography. All patients had a good neurological outcome and no major complication occurred. Brain retractors were never used during surgery, the frontal sinus was never opened neither, and anosmia was never observed after surgery. Anterior interhemispheric approach seems to be safe and effective to treat AF-DAVF with lower risks than other surgical approaches. This technique could be more widely considered when facing such midline vascular lesion.

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Data availability

The data that support the findings of this study are available from the corresponding author.

Code availability

Not applicable.

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Authors and Affiliations

  1. Department of Neurosurgery, Pitié-Salpêtrière University Hospital, 47-83 Boulevard de l’hôpital, 75013, Paris, France

    Etienne Lefevre, Soledad Navarro, Stephane Clemenceau, Anne-Laure Boch, Michel Kalamarides, Alexandre Carpentier & Aurélien Nouet

  2. Sorbonne University, UPMC, Paris, France

    Etienne Lefevre, Stéphanie Lenck, Soledad Navarro, Stephane Clemenceau, Anne-Laure Boch, Sophie Dupont, Vincent Degos, Frédéric Clarençon, Michel Kalamarides, Alexandre Carpentier & Aurélien Nouet

  3. Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France

    Stéphanie Lenck & Frédéric Clarençon

  4. Epilepsy and Rehabilitation Units, APHP, Pitié-Salpêtrière Hospital, Paris, France

    Sophie Dupont

  5. Centre de Recherche de L’Institut du Cerveau Et de La Moelle Épinière (ICM), UMPC-UMR 7225 CNRS-UMRS 975 Inserm, Paris, France

    Sophie Dupont

  6. GRC 29, APHP, DMU DREAM, Department of Anesthesia and Intensive Care, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France

    Vincent Degos

Authors
  1. Etienne Lefevre
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  2. Stéphanie Lenck
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  11. Aurélien Nouet
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Contributions

Aurelien Nouet designed the study and supervised the findings of this work.

Etienne Lefevre drafted the manuscript and designed the figures with support from Aurelien Nouet.

All authors contributed to the analysis of the results and to the writing of the final manuscript.

Stephanie Lenck, Soledad Navarro, Stephane Clemenceau, Anne-Laure Boch, Sophie Dupont, Vincent Degos, Frederic Clarençon, Michel Kalamarides, and Alexandre Carpentier discussed the results and contributed to the final manuscript.

Corresponding author

Correspondence to Aurélien Nouet.

Ethics declarations

Ethics approval

Approval was obtained from our institutional ethics board (number IRB00011687).

Consent to participate

All the patients have given written consent for this retrospective analysis of anonymized data.

Consent for publication

All the patients have given written consent for this retrospective analysis of anonymized data.

Conflict of interest

The authors declare no competing interests.

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The manuscript has not been submitted elsewhere nor published elsewhere in whole or in part.

Supplementary Information

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Supplementary file1 (MP4 328053 KB) Video 1 Two-dimensional operative video of an anterior fossa dural arteriovenous fistula operated on via an anterior interhemispheric approach.

Supplementary file2 (DOCX 33 KB)

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Lefevre, E., Lenck, S., Navarro, S. et al. Anterior interhemispheric approach for anterior fossa dural arteriovenous fistulas. Neurosurg Rev 45, 1791–1797 (2022). https://doi.org/10.1007/s10143-021-01658-3

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  • DOI: https://doi.org/10.1007/s10143-021-01658-3

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