Surgical Clipping of a Petrosal Tentorial Dural Arteriovenous Fistula (Lawton's Type 5)

Javier Ros de San Pedro; Beatriz Cuartero-Pérez

doi:10.1055/s-0038-1675171

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2019; 80(S 03): S333-S334
DOI: 10.1055/s-0038-1675171

Skull Base: Operative Videos

Georg Thieme Verlag KG Stuttgart · New York

Surgical Clipping of a Petrosal Tentorial Dural Arteriovenous Fistula (Lawton's Type 5)

Authors

Javier Ros de San Pedro

¹Regional Service of Neurosurgery, Vascular Neurosurgery Unit, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar (Murcia), Spain
Beatriz Cuartero-Pérez

¹Regional Service of Neurosurgery, Vascular Neurosurgery Unit, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar (Murcia), Spain

Abstract

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Keywords

cerebellopontine angle - dural arteriovenous fistula - superior petrosal vein - Lawton's type 5 tentorial fistula - retrosigmoid craniotomy - superior petrosal sinus

Fig. 1 Comparison between pre- and postoperative cerebral angiogram. The upper left image corresponds to a preop anterior–posterior view after left ECA injection. The two main final branches of the ECA, namely, the STA and the IMA are depicted. Multiple transpetrous branches coming off the latter feed the lateral tentorial DAVF, which drains directly into the SPV and secondarily into the left RBV. The upper right image corresponds to a lateral view of the same left ECA injection. Notice the clear depiction of the different DAVF components: the multiple tentorial and transpetrous feeders, the single fistulous vein, namely the SPV, and how this vein subsequently drains into the RBV, which drains both anterograde and retrograde. The lower left image is the postop equivalent to the upper left image, demonstrating the final exclusion of the DAVF, with no longer early filling of the SPV and RBV. The lower right image is the postop equivalent of the upper right image, which again shows a normal extracranial vasculature after DAVF exclusion. DAVF, dural arteriovenous fistula; ECA, external carotid artery; IMA, internal maxillary artery; external carotid artery; preop, preoperative; postop, postoperative; RBV, Rosenthal's basal vein; SPV, superior petrosal vein; STA, superficial temporal artery.

Fig. 2 Intraoperative images through a left retrosigmoid craniotomy. (A) Complete exposure of the fistulous DAVF vein at the CPA. The root of the fistulous vein is located just between the petrous bone and the tentorium. (B) Clip application close to the base of the fistulous vein. Notice the left trigeminal nerve right behind the DAVF origin. (C) Intraoperative image after indocyanine green injection, which clearly shows the sparkling enhancement of the SPV after clip opening for DAVF occlusion checking. (D) Postclipping checking of the tentorial DAVF and CPA structures. Notice the bluish and slack aspect of the DAVF vein with the clip at its base. The vein is moved cranially with a dissector to expose both the trigeminal nerve and the VII, VIII complex. CPA, cerebellopontine angle; DAVF, dural arteriovenous fistula; SPV, superior petrosal vein.

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Figures

Fig. 1 Comparison between pre- and postoperative cerebral angiogram. The upper left image corresponds to a preop anterior–posterior view after left ECA injection. The two main final branches of the ECA, namely, the STA and the IMA are depicted. Multiple transpetrous branches coming off the latter feed the lateral tentorial DAVF, which drains directly into the SPV and secondarily into the left RBV. The upper right image corresponds to a lateral view of the same left ECA injection. Notice the clear depiction of the different DAVF components: the multiple tentorial and transpetrous feeders, the single fistulous vein, namely the SPV, and how this vein subsequently drains into the RBV, which drains both anterograde and retrograde. The lower left image is the postop equivalent to the upper left image, demonstrating the final exclusion of the DAVF, with no longer early filling of the SPV and RBV. The lower right image is the postop equivalent of the upper right image, which again shows a normal extracranial vasculature after DAVF exclusion. DAVF, dural arteriovenous fistula; ECA, external carotid artery; IMA, internal maxillary artery; external carotid artery; preop, preoperative; postop, postoperative; RBV, Rosenthal's basal vein; SPV, superior petrosal vein; STA, superficial temporal artery.

Fig. 2 Intraoperative images through a left retrosigmoid craniotomy. (A) Complete exposure of the fistulous DAVF vein at the CPA. The root of the fistulous vein is located just between the petrous bone and the tentorium. (B) Clip application close to the base of the fistulous vein. Notice the left trigeminal nerve right behind the DAVF origin. (C) Intraoperative image after indocyanine green injection, which clearly shows the sparkling enhancement of the SPV after clip opening for DAVF occlusion checking. (D) Postclipping checking of the tentorial DAVF and CPA structures. Notice the bluish and slack aspect of the DAVF vein with the clip at its base. The vein is moved cranially with a dissector to expose both the trigeminal nerve and the VII, VIII complex. CPA, cerebellopontine angle; DAVF, dural arteriovenous fistula; SPV, superior petrosal vein.