Surgical Management of Dural Arteriovenous Fistula of the Anterior Cranial Fossa after Failure of Embolization Therapy: Case Report

Dural arteriovenous fistula (DAVF) of anterior cranial fossa is a rare entity. The authors report a 57 year-old man presented with retro-orbital headache caused by a large hematoma in the right frontal lobe. Angiography demonstrated a DAVF of anterior cranial fossa fed by branches of middle meningeal and anterior ethmoidal artery. Endovascular therapy using N-butyl cyanoacrylate was tried, however, was failed to occlude the fistula. After than, the lesion was successfully obliterated by surgical means. The therapeutic roles and pitfalls of endovascular treatment and surgical treatment for the anterior fossa DAVF are discussed.

A Fatal Complication Associated with Combined Posterior Petrous and Suboccipital Approach to a Giant Jugular Foramen Schwannoma

Schwannomas of the jugular foramen, originating from the glossopharyngeal nerve, vagus and accessory nerve represent approximately 0.17-0.72% of all intracranial tumor, and consists of 1.4-2.9% of all intracranial schwannomas. The clinical presentation of these tumors varies significantly according to originated nerve and it's growth pattern. Magnetic resonance(MR) image and temporal bone computed tomography(CT) scan have a major role for diagnosis of such tumor. The treatment of choice is total resection whenever possible. Generally, suboccipital approach is sufficient for the removal of the tumor, but in case with large size, combination of resection of petrous part of temporal bone with or without transection of sigmoid sinus is may be necessory. We have recently experienced one case of giant jugular foramen schwannoma and postoperative fatal complication in a 34-year-old male who was treated with combined posterior petrous and suboccipital approach with transection of sigmoid sinus.