The short-to-mid-term curative effect of hybrid surgery for complex dural arteriovenous fistula

Objective: To explore the short-to-mid-term curative effect of hybrid surgery for complex dural arteriovenous fistula (DAVF). Methods: The clinical data of 20 patients with DAVF, who were admitted to Southern Hospital of Southern Medical University of China during the period from January 2017 to December 2018, were retrospective analyzed. Among the 20 patients, 8 patients who met the inclusion criteria received hybrid surgery. After treatment, the patients were periodically followed up, reexaminations of cerebral CT/MRI and DSA were performed to assess the closure status of fistula, the neurological functions were evaluated, and the changes in Rankin scale (mRS) scores were recorded. Results: Intraoperative instant angiography showed that complete occlusion of fistula was achieved in 7 patients (7/8) and subtotal occlusion of fistula was achieved in one patient (1/8). Two weeks after treatment, one patient died due to sudden pulmonary embolism. The patients were followed up for 3-24 months, CT/MRI and DSA examination revealed that satisfactory recovery was obtained in 7 patients and no newly-developed neurological dysfunction was observed. Conclusion: For the treatment of complex DAVF associated with venous sinus occlusion or multiple 'common channels', hybrid surgery can provide a clear therapeutic approach, and through a single comprehensive surgery a complete and permanent occlusion of the fistula can be achieved with satisfactory short-to-mid-term effect. (authors)