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This is a Experimental Study study.

October 2, 2025Open Access

Supraorbital eyebrow approach for ligation of an anterior fossa combined dural and pial arteriovenous fistula

Key Points

The supraorbital eyebrow approach successfully ligated an anterior fossa arteriovenous fistula, enhancing safety.
A 72-year-old male showed improved symptoms following a minimally invasive craniotomy for AVF treatment.
Microsurgical techniques prevent excessive brain retraction, maintaining cosmetic outcomes in AVF surgery.
The surgical approach minimizes risks associated with ethmoidal artery involvement in AVF cases.

Abstract

Microsurgical treatment of arteriovenous fistulas (AVFs) of the anterior fossa is indicated when endovascular approaches carry excessive risk due to the involvement of the ethmoidal arteries. A 72-year-old male presenting with episodes of blurred vision was found to have an atypical Cognard type IV ethmoidal AVF with combined dural and pial supply from an orbitofrontal branch. He underwent supraorbital craniotomy via eyebrow incision for successful clip ligation of the AVF at the cribriform plate. The supraorbital eyebrow approach offers a minimally invasive corridor, enabling direct visualization and disconnection of anterior fossa AVFs while minimizing brain retraction and cosmetic impact. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2559

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