How I do it: exoscopic disconnection of anterior fossa dural arteriovenous fistulae

Abstract

BACKGROUND: Brain Dural Arteriovenous Fistulae (DAVF) are acquired abnormal connections between dural arteries and cerebral veins or venous sinuses. Disconnection of the pathological shunt is recommended for high-grade fistulae and cases with intolerable symptoms or previous bleedings. Surgical disconnection remains the preferred method for anterior fossa DAVF. METHOD: Microsurgical disconnection of anterior fossa DAVF is performed with the assistance of a robotic exoscope. Intraoperative aniography is implemented to confirm the exclusion of DAVF. CONCLUSION: The exoscope provides excellent lighting and magnification in challenging surgical fields improving surgeon's ergonomics and enabling tailored, minimally invasive approaches without compromising procedural safety or effectiveness.