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Indian Journal of Neurosurgery 2012; 01(02): 144-148
DOI: 10.4103/2277-9167.102285
Case Report
Thieme Medical and Scientific Publishers Private Ltd.

Giant tentorial dural arteriovenous fistula treated by a combination of trans-arterial embolization and surgery

Türker Karancı
,
Hidayet Akdemir
,
Kubilay Aydın
1   Department of Interventional Neuroradiology, Istanbul University, School of Medicine, Istanbul, Turkey
› Author Affiliations
Subject Editor:
Further Information

Publication History

Publication Date:
18 January 2017 (online)

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Abstract

Tentorial dural arteriovenous fistulae are uncommon lesions but can be life-threatening. A 34-year-old male presented with intractable headache, seizures, and visual disturbance. Three-dimensional computed tomography (CT) angiography and digital subtraction angiography demonstrated a right tentorial dural arteriovenous fistula supplied by both internal and external carotid systems and draining into a giant venous ampula. Transarterial embolization of the external carotid feeders with Onyx (TM, ev3, Irvine, CA) was carried out. Postembolization angiography revealed persistence of a portion of the fistula supplied by the temporo-occipital branch of right middle cerebral artery. The patient underwent right temporo-occipital craniotomy, division of the feeders and resection of the entire fistula and coagulation of the leptomeningeal arterialized veins. Complete elimination of the fistula was demonstrated by angiography. Postoperative recovery was uneventful; the patient did not develop any fresh neurologic deficits. We review the relevant literature and discuss the rationale for managing these lesions.

Key words

Surgery - tentorial dural arterio-venous fistula - trans-arterial embolization
 

  • References

  • 1 Awad IA, Little JR, Akarawi WP, Ahl J. Intracranial dural arteriovenous malformation: Factors predisposing to an aggressive neurological course. J Neurosurg 1990; 72: 839-850
    CrossrefPubMedGoogle Scholar
  • 2 Zhou LF, Chen L, Song DL, Gu YX, Leng B. Tentorial dural arteriovenous fistulas. Surg Neurol 2007; 67: 472-482
    CrossrefPubMedGoogle Scholar
  • 3 Benndorf G, Schmidt S, Sollmann WP, Kroppenstedt SN. Tentorial dural arteriovenous fistula presenting with various visual symptoms related to anterior and posterior visual pathway, dysfunction, Case report. J Neurosurg 2003; 53: 222-226
    CrossrefPubMedGoogle Scholar
  • 4 Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A. et al Cerebral dural arteriovenous fistulas: Clinical and angiographic correlation with a revised classification of venous drainage. Radiology 1995; 194: 671-680
    CrossrefPubMedGoogle Scholar
  • 5 Zhou LF, Chen L, Song DL, Gu YX, Leng B. Tentorial dural arteriovenous fistulas. Surg Neurol 2007; 67: 472-482
    CrossrefPubMedGoogle Scholar
  • 6 Liu JK, Dogan A, Ellegala DB, Carlson J, Nesbit GM, Barnwell SL. et al The role of surgery for high-grade intracranial dural arteriovenous fistulas: Importance of obliteration of venous outflow. J Neurosurg 2008; 110: 913-920
    PubMedGoogle Scholar
  • 7 Davis MA, Ter Brugge K, Willinsky RA, Wallace MC. The natural history and management of intracranial dural arteriovenous fistulae: Part 2, Aggressive lesions. Int Neuroradiol 1997; 3: 303-311
    PubMedGoogle Scholar
  • 8 Hoh BL, Choudhri TF, Connoly Jr ES, Solomon RA. Surgical management of high-grade intracranial dural arteriovenous fistulas: Leptomeningeal venous disruption without nidus excision. Neurosurgery 1998; 42: 796-805
    CrossrefPubMedGoogle Scholar
  • 9 Liu JK, Dogan A, Ellegala DB, Carlson J, Nesbit GM, Barnwell SL. et al The role of surgery for high-grade intracranial dural arterio-venous fistulas: Importance of obliteration of venous outflow. J Neurosurg 2009; 110: 913-920
    CrossrefPubMedGoogle Scholar
  • 10 Kallmes DF, Jensen ME, Cloft HJ, Kassell NF, Dion JE. Percutaneous transvenous coil embolisation of a Djindjian type 4 tentorial dural arteriovenous malformation. Am J Neuroradiol 1997; 18: 673-676
    PubMedGoogle Scholar
  • 11 Malik GM, Pearce JE, Ausman JI, Mehta B. Dural arteriovenous malformations and intracranial hemorrhage. Neurosurgery 1984; 15: 332-339
    CrossrefPubMedGoogle Scholar
  • 12 Borden JA, Wu JK, Shucart WA. A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 1995; 82: 166-179
    CrossrefPubMedGoogle Scholar
  • 13 Deasy NP, Gholkar AR, Cox TC, Jeffree MA. Tentorial dural arteriovenous fistulae: Endovascular treatment with transvenous coil embolisation. Neuroradiology 1999; 41: 308-312
    CrossrefPubMedGoogle Scholar
  • 14 Lewis AI, Tomsick TA, Tew Jr JM. Management of tentorial dural arteriovenous malformations: Transarterial embolisation combined with stereotactic radiation or surgery. J Neurosurg 1994; 81: 851-859
    CrossrefPubMedGoogle Scholar
  • 15 Davies MA, Ter Brugge K, Willinsky R, Coyne T, Saleh J, Wallace MC. The validity of classification for the clinical presentation of intracranial dural arteriovenous fistulas. J Neurosurg 1996; 85: 830-837
    CrossrefPubMedGoogle Scholar
  • 16 Borha A, Emery E, Courtheoux P. Tentorial dural fistulas with giant venous ampulae treated with embolisation and surgery. A case report. Acta Neurochir 2010; 152: 1745-1753
    PubMedGoogle Scholar
  • 17 Awad IA, Barnett GH. Neurological deterioration in a patient with a spinal arteriovenous malformation following lumbar puncture. Case report. J Neurosurg 1990; 72: 650-653
    PubMedGoogle Scholar
  • 18 Chandler Jr HC, Freidman WA. Successful radio surgical treatment of a dural arterio-venous malformation. Case report. Neurosurgery 1993; 33: 139-142
    PubMedGoogle Scholar
  • 19 Enker SH. Progression of a dural arteriovenous malformation resulting in an intracerebral hematoma: A case report. Angiology 1979; 30: 198-204
    CrossrefPubMedGoogle Scholar
  • 20 Thompson BG, Doppman JL, Oldfield EH. Treatment of cranial dural arteriovenous fistulae by interruption of leptomeningeal venous drainage. J Neurosurg 1994; 80: 617-623
    CrossrefPubMedGoogle Scholar
  • 21 Duffau H, Lopes M, Janosevic V, Sichez JP, Faillot T, Capelle L. et al Early rebleeding from intracranial dural arteriovenous fistulas: Report of 20 cases and review of the literature. J Neurosurg 1999; 90: 78-84
    CrossrefPubMedGoogle Scholar
  • 22 Barnwell SL, Halbach VV, Higashida RT, Hieshima G, Wilson CB. Complex dural arteriovenous fistulas. Result of combined endovascular and neurosurgical treatment in 16 patients. J Neurosurg 1989; 71: 352-358
    CrossrefPubMedGoogle Scholar
  • 23 Collice M, DAliberti G, Talamonti G, Branca V, Boccardi E, Scialfa G. et al Surgical interruption of leptomeningeal drainage as treatment for intracranial dural arteriovenous fistulas without dural sinus drainage. J Neurosurgery 1996; 84: 810-817
    CrossrefPubMedGoogle Scholar
  • 24 Halbach VV, Higashida RT, Hieshima GB, Goto K, Norman D, Newton TH. Dural fistulas involving the transverse and sigmoid sinuses: Results of treatment in 28 patients. Radiology 1987; 163: 443-447
    CrossrefPubMedGoogle Scholar
  • 25 Hardy RW, Costin JA, Weinstein M, Berlin Jr AJ, Gutman FA. External carotid cavernous fistula treated by transfemoral embolisation. Surg Neurol 1978; 9: 255-256
    PubMedGoogle Scholar
  • 26 Vinuela FV, Debrun GM, Fox AJ, Kan S. Detachable calibrated-leak balloon for super selective angiography and embolisation of dural arteriovenous malformations. J Neurosurg 1983; 58: 817-823
    CrossrefPubMedGoogle Scholar
  • 27 Freidman JA, Pollock BE, Nicholas DA, Gorman DA, Foote RL, Stafford SL. Results of combined stereotactic radiosurgery and trans-arterial embolisation for dural arterio-venous fistulas of the transverse and sigmoid sinuses. J Neurosurg 2001; 94: 886-891
    CrossrefPubMedGoogle Scholar
  • 28 Link MJ, Coffey RJ, Nichols DA, Gorman DA. The role of radiosurgery and particulate embolisation in the treatment of dural arteriovenous fistulas. J Neurosurg 1996; 84: 804-809
    CrossrefPubMedGoogle Scholar
  • 29 Pan DH, Chung WY, Guo WY, Wu HM, Liu KD, Shiau CY. et al Stereotactic radiosurgery for the treatment of dural arteriovenous fistulas involving the transverse-sigmoid sinus. J Neurosurg 2002; 96: 823-829
    CrossrefPubMedGoogle Scholar
  • 30 Iwamuro Y, Nakahara I, Higashi T, Iwaasa M, Watanabe Y, Hirata E. et al Tentorial dural arteriovenous fistula presenting symptoms due to mass effect on the dilated draining vein. Case report. Surg Neurol 2005; 65: 511-515
    PubMedGoogle Scholar
  • 31 Pannu Y, Shownkeen H, Nockels RP, Origitano TC. Obliteration of a tentorial dural arteriovenous fistula causing spinal cord myelopathy using the cranio-orbito zygomatic approach. Surg Neurol 2004; 62: 463-467
    CrossrefPubMedGoogle Scholar