Temporary clamping of bilateral external carotid arteries for surgical excision of a complex dural arteriovenous fistula
A 52-year-old male presented with head heaviness and headache, which he had for 3 weeks. He was sent to our emergency room due to his syncope and seizure. Computed tomography (CT) angiography of the brain revealed no intracranial hemorrhage but did show numerous engorged vessels in bilateral cerebral hemisphere and superficial scalp. However, digital subtraction angiography (DSA) showed numerous arterial feeders from the bilateral parietal-occipital scalp and dura, which shunted into superior saggital sinus with cerebral venous reflux, compatible with DAVFs, Cognard type IIb [Figure and ]. Urgent surgical intervention for excision of fistulas and skeletonization of the diseased sinus was performed after temporary clamping of bilateral ECAs. Intraoperative angiogram showed complete obliteration of fistula and normal venous return [Figure and ]. Eventually, the patient had good recovery without any morbidity. The modified Rankin scale (mRS) was also zero at discharge.