Hybrid surgical and endovascular treatment

Abstract High-risk dural arteriovenous fistulas, defined as fistulas with cortical venous reflux, can be treated with both endovascular and open surgical techniques. However, in challenging cases in which surgical risk is high and traditional endovascular access via transarterial or transvenous routes is not obtainable, hybrid open surgical and endovascular techniques can be used. This chapter reviews cases from the literature exploring these novel approaches with illustrative examples and discusses the indications and nuances of performing hybrid surgical and endovascular procedures for these challenging lesions in the modern neuroendovascular era.