Clipping of bilateral ethmoidal dural arteriovenous fistula using a bifrontal approach

We present management of a 59-year-old female with a recent history of migraine. Angiography demonstrated bilateral shunting directly into the superior sagittal sinus (SSS) via ethmoidal arteries arising from both OpA, and a 5 mm basilar tip aneurysm projecting postero-superiorly. Since the fistula had a higher risk of hemorrhage, aneurysm occlusion was deferred for treatment at a later time. Endovascular occlusion of the dAVF was not feasible due to the high risk of catherization of OpA, and the patient agreed to microsurgical treatment. A bifrontal craniotomy ligation of SSS was required to allow access to the crista galli. After occlusion of the arterial feeders, clips were placed to occlude the origin of SSS and avoid fistula recurrence. The patient was discharged without complications, and post-operative angiography showed complete occlusion of the fistula and flow on SSS. This facilitated future antiplatelet therapy for endovascular treatment of the basilar aneurysm.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research