• Basil E Grüter, Fabio Strange, Felice Burn, Luca Remonda, Michael Diepers, Javier Fandino, and Serge Marbacher.
• Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland. Electronic address: basil.grueter@ksa.ch.
• World Neurosurg. 2018 Dec 1; 120: e932-e939.

ObjectiveDural arteriovenous fistulas (dAVFs) are abnormal direct shunts between the occipital or meningeal artery and a meningeal vein or dural venous sinus. Treatment strategies include endovascular, microsurgical, stereotactic radiosurgical, or combined interventions. With few previous reports focused on dAVF treatment in a hybrid operating room (hOR), the authors reviewed their 6-year experience in this unique setting for these complex fistulas.MethodsPatients with complex cerebral dAVFs underwent endovascular and microsurgical treatment in the hOR. In this retrospective review, 8 consecutive patients with cerebral dAVFs (Borden type 2 or higher) underwent endovascular and microsurgical treatment. Demographic characteristics, symptoms related to the dAVF, preoperative angiographic features, preinterventional therapies, intraoperative digital subtraction angiography (iDSA), and postoperative clinical and radiologic findings were reviewed.ResultsOf these 8 patients, 5 patients underwent multiple embolizations (up to 3) and hybrid procedures, with no procedure-related complications. After microsurgical resection, iDSA revealed remnants of the fistula, which was then immediately re-resected, in 2 patients. At closing of the hybrid procedure, iDSA revealed no fistula remnants in 7 patients (88%). At mean follow-up examination (58 months), 5 patients (62%) had cure of the dAVF, confirmed by noninvasive angiography. Two patients (25%) experienced a recurrence of the dAVF within 5 months.ConclusionsOur hybrid techniques achieved high rates of dAVF obliteration, with all 8 patients achieving good or excellent outcomes and symptom relief. Angiographic follow-up within 6 months after the hybrid procedure is recommended for all patients even when intraoperative findings do not show remnants.Copyright © 2018 Elsevier Inc. All rights reserved.

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