Mini-pterional approach for clip ligation of ethmoidal dural arteriovenous fistula
Ethmoidal dural arteriovenous fistulas (DAVFs) have a near-universal association with cortical venous drainage and a malignant clinical course. Endovascular treatment options are often limited due to the high frequency of ophthalmic artery ethmoidal supply. A 64-year-old gentleman presented with syncope and was found to have a right ethmoidal DAVF. Rather than the traditional bicoronal craniotomy, an endoscope-assisted mini-pterional approach for clip ligation is demonstrated. The mini-pterional craniotomy allows a minimally invasive approach to ethmoidal DAVF via a lateral trajectory. The endoscope can help achieve full visualization in the narrow corridor. Robert T. Wicks, MD,1 Xiaochun Zhao, MD,1 Douglas A. Hardesty, MD,2 Brandon D. Liebelt, MD,3 and Peter Nakaji, MD1 1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, Arizona; 2Department of Neurological Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio; and 3Department of Neurological Surgery, University of Vermont Medical Center, Burlington, Vermont
