Department of Neurosurgery, NYU Langone Health, New York , New York , USA.
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York , New York , USA.
Oper Neurosurg (Hagerstown). 2024 Sep 1;27(3):303-308. doi: 10.1227/ons.0000000000001103. Epub 2024 Feb 20.
Inherent complex angioarchitecture associated with ethmoidal dural arteriovenous fistulas (dAVFs) can make endovascular treatment methods challenging. Many surgical approaches are accompanied by unfavorable cosmetic results such as facial scarring. Blepharoplasty incision of the eyelid offers a minimal, well-hidden scar compared with other incision sites while offering the surgeon optimal visualization of pathogenic structures. This case series aims to report an initial assessment of the safety and efficacy of supraorbital craniotomy by blepharoplasty transpalpebral (eyelid) incision for surgical disconnection of ethmoidal dAVFs.
Retrospective chart review was conducted for all patients who underwent blepharoplasty incision and craniotomy for disconnection of ethmoidal dAVFs at our institution between October 2011 and February 2023. Patient charts and follow-up imaging were reviewed to report clinical and angiographic outcomes as well as periprocedural and follow-up complications.
Complete obliteration and disconnection of ethmoidal dAVF was achieved in all 6 (100%) patients as confirmed by intraoperative angiogram with no resulting morbidity or mortality. Periprocedural complications included one case of transient nasal cerebrospinal fluid leak that was self-limiting and resolved before discharge without intervention.
Surgical treatment for ethmoidal dAVFs, specifically by transpalpebral incision and supraorbital craniotomy, is a safe and effective treatment option and affords the surgeon greater access to the floor of the anterior fossa when necessary. In addition, blepharoplasty incision addressed patient concerns for facial scarring compared with other incision sites by creating a more well-hidden, minimal scar in the natural folds of the eyelid for patients with an eyelid crease.
与筛骨硬脑膜动静脉瘘（dAVF）相关的固有复杂血管结构使得血管内治疗方法具有挑战性。许多手术方法伴随着不理想的美容效果，例如面部疤痕。与其他切口部位相比，眼睑切开术的睑成形术切口可提供最小的、隐藏良好的疤痕，同时为外科医生提供最佳的致病结构可视化效果。本病例系列旨在报告通过经眼睑（眼睑）切开眶上颅骨切开术初次评估手术切断筛骨 dAVF 的安全性和有效性。
对 2011 年 10 月至 2023 年 2 月期间在我院接受经眼睑切开术和颅骨切开术以切断筛骨 dAVF 的所有患者进行回顾性图表审查。回顾患者图表和随访影像，以报告临床和血管造影结果以及围手术期和随访并发症。
所有 6 例（100%）患者均通过术中血管造影证实完全闭塞和 dAVF 断开，无任何发病率或死亡率。围手术期并发症包括一例短暂性鼻脑脊液漏，该病例自行限制并在出院前无需干预的情况下解决。
筛骨 dAVF 的手术治疗，特别是通过经眼睑切开术和眶上颅骨切开术，是一种安全有效的治疗选择，并为外科医生提供了更大的进入前颅窝底部的通道，在必要时。此外，与其他切口部位相比，睑成形术切口通过在眼睑褶皱的自然褶皱处形成更隐藏、最小的疤痕，解决了患者对面部疤痕的担忧，对于有眼睑折痕的患者。
