Diagnosis And Treatment Of Superior Petrosal Sinus Dural Arteriovenous Fistula (Analysis Of 10 Cases)

Objective: Superior petrosal sinus dural arteriovenous fistula(DAVF)are uncommon but life-threatened lesions.To investigate the clinical characteristics and the treatment strategies of superior petrosal sinus DAVF and to review the relevant literature.Methods: The clinical data of ten patitents with superior petrosal sinus DAVF who were admitted to the Department of Neurosurgery,Tongji Hospital,Huazhong University of Science and Technology from September 2015 to January 2017 were retrospectively studied,including their history,imaging data,and follow-up data.All patients underwent craniotomy with the coagulation of the fistula,disconnection of leptomeningeal venous drainage.Fluorescein angiography was used during the procedure.The patients were followed up at 3 months examination in outpatient,6 months by DSA.All the patients followed with a mean following-up time of 9 months(range 3-16 months).Results: There were 6 females and 4 males with ages from 39 to 64 years(average,52.5 years).Clinical manifestations were acute subarachnoid hemorrhage in 6 cases,progressing neurological deficits in 4 cases.One patient presented with quadriplegia and dyspnea,had clinical improvement after craniotomy,but finally was out of hospital because of financial difficulty with a Modified Rankin Scale 5.All the patients had clinical improvement,there was no surgical mortality and morbidity.Postoperative DSA confirmed obliteration of superior petrosal sinus DAVF in 9 cases.The remaining patients followed had a good outcome(Modified Rankin scale 0 in six patients,1 in three people).Follow-up study ranging from 3 to 16 months showed no recurrence and all patients resume their full activities.Conclusion: Superior petrosal sinus DAVF is an aggressive vascular lesion,causing subarachnoid hemorrhage and progressive neurological deficits.Prompt diagnosis and definite treatment for superior DAVF are mandatory.Obliteration of the nidus and/or leptomeningeal venous drainage should be the goal of treatment procedures.