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Interpositional dural graft technique for the treatment of dural arteriovenous fistulas.

Dural arteriovenous fistulas (dAVFs) are acquired direct arteriovenous shunts that often drain into the dural venous sinus. Treatment options generally involve disrupting the abnormal vascular conduits by using a combination of modalities, including surgical disconnection, radiosurgery, and transarterial and transvenous embolization. Often these modalities provide only partial treatment of fistulous lesions, and thus the fistula recurs and symptoms result. The authors report on a novel surgical technique in which the involved venous sinuses are skeletonized and an interpositional dural substitute is placed between the disconnected sinus and native dura mater and over the pial surface adjacent to the sinus. The technique, which is demonstrated in an illustrative case, is intended to preserve native venous drainage and to prevent recruitment of new vascularization to the venous sinus postoperatively. The authors have not observed reconstitution of fistulas over areas treated with this technique, which offers the advantage of inhibiting vascular ingrowth (refistulization) while maintaining venous sinus patency.