Surgical treatment of intracranial dural arteriovenous fistulae: role of venous drainage.

Objective: This report focuses on the surgical management of aggressive intracranial dural arteriovenous fistulae (d-AVFs), which are defined as fistulae with arterialized leptomeningeal veins (red veins). Particular attention is paid to the accurate identification of the venous drainage pattern and to the choice of the proper treatment strategy.

Methods: Thirty-four consecutive patients with aggressive intracranial d-AVFs were treated between 1994 and 1998.

Multidisciplinary (surgical and endovascular) approach to intracranial aneurysms.

In spite of the availability of the new endovascular technique (GDC) to manage cerebral aneurysms, to date, the crucial question "which is the proper treatment in a given patient?" still remains unsettled. In order to check whether an answer is possible, we retrospectively reviewed a personal series of 192 consecutive patients with cerebral aneurysms (1993-1995). We found 164 patients who had been considered eligible for active aneurysm treatment.

Surgical treatment of poor-grade aneurysm patients.

Patients who are severely struck by subarachnoid hemorrhage (the so called poor-grades) have been usually considered almost hopeless. Conversely, it is now becoming apparent that a significant number of poor grades could be perhaps salvageable during the first hours after the hemorrhage. In this paper we are reporting the results of an aggressive management protocol including immediate intensive care management and early surgery.

Prevention and treatment of vasospasm.

Cerebral vasospasm is a frequent and severe complication of SAH. Angiographic vasospasm may be seen in 70% of patients and delayed cerebral ischemic deficits are observed in 30% of patients. Since vasodilator drugs cannot reverse cerebral vasospasm, treatment is directed to prevent vasospasm and to prevent or reverse ischemic deficits.

[Anesthesia in early surgery and endovascular therapy for aneurysmic subarachnoid hemorrhage].

Early surgery after SAH is frequently performed. The most important problems for anesthesiologists are the risk of rebleeding, the alteration of autoregulation and CO2 responsiveness, cardiac, respiratory and electrolytic alterations. In this phase the brain may be ischemic-edematous or haemorrhagic-compressive and the choice of anesthetic agent is made on the basis of cerebral conditions.