• Je Hun Jang, Won-Sang Cho, Hyun-Seung Kang, and Jeong Eun Kim.
• Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea.
• World Neurosurg. 2019 Oct 1; 130: 89-94.

BackgroundSurgical obliteration is generally recommended for anterior cranial fossa dural arteriovenous fistulas (ACF DAVFs) because of a high risk of bleeding and the difficulty of endovascular approaches. Surgical obliteration is generally performed via a frontobasal craniotomy; however, it is slightly excessive over the target fistula. Here, we present 2 cases of ACF DAVFs treated with small craniotomy without frontal sinus involvement and a review of the related literature.MethodsWe present 2 cases including a 63-year-old woman who presented with a right-sided ACF DAVF that was fed by both ethmoidal arteries and drained into the right cortical veins (case 1) and a 59-year-old man with right-sided unruptured multiple aneurysms and a left-sided ACF DAVF that was fed by the right ethmoidal artery and drained into the left cortical veins (case 2).ResultsCase 1 underwent surgical obliteration via a right high frontal craniotomy. Case 2 was simultaneously treated with surgical clipping of the multiple aneurysms via a right lateral supraorbital craniotomy and surgical obliteration of the ACF DAVF via a left high frontal craniotomy. These 2 patients had no neurologic deficits, and complete obliteration of all the lesions was confirmed on cerebral angiography.ConclusionsConstructing a small corridor and a deep working distance in unilateral small high frontal craniotomy may be a slightly unusual approach; however, it is thought to provide sufficient space and a range of microscopic views that facilitate surgical manipulation without requiring extensive bone work.Copyright © 2019 Elsevier Inc. All rights reserved.

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