An Intraoperative Look at a Residual/Recurrent Tentorial Dural Arteriovenous Fistula

Authors

Bradley A. Gross, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. Electronic address: grossb2@upmc.edu.
Andrew F. Ducruet, Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.Follow
Brian T. Jankowitz, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Paul A. Gardner, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

Document Type

Article

Abstract

BACKGROUND: Dural arteriovenous fistulas (dAVFs) often are treated via transarterial or transvenous embolization. Incomplete penetration of the draining vein/occult residual often will become apparent on follow-up angiography, requiring repeat embolization, or at times, surgical resection. CASE DESCRIPTION: A 41-year-old woman presented with cerebellar hemorrhage from a tentorial dAVF treated with transvenous coil embolization. Follow-up angiography disclosed a residual/recurrent fistula treated with transvenous Onyx embolization. After further follow-up angiography demonstrated another occult residual/recurrence, the fistula was disconnected with the tentorial dura excised via a retrosigmoid approach. Six-month follow-up angiography demonstrated no recurrence. CONCLUSIONS: Although endovascular treatment of dAVFs is generally first-line therapy, surgical disconnection of fistulas, particularly high-risk residual/recurrent fistulas, is an excellent option in well-selected cases.

Keywords

Arteriovenous fistula, Dural arteriovenous fistula, Embolization, Recurrence, Surgery

Medical Subject Headings

Adult; Central Nervous System Vascular Malformations (diagnostic imaging, surgery); Female; Humans; Monitoring, Intraoperative (methods); Recurrence; Spinal Cord (diagnostic imaging, surgery)

Publication Date

9-1-2017

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

105

First Page

1043.e7

Last Page

1043.e9

PubMed ID

28711532

Digital Object Identifier (DOI)

10.1016/j.wneu.2017.07.015

Recommended Citation

Gross, Bradley A.; Ducruet, Andrew F.; Jankowitz, Brian T.; and Gardner, Paul A., "An Intraoperative Look at a Residual/Recurrent Tentorial Dural Arteriovenous Fistula" (2017). Translational Neuroscience. 2060.
https://scholar.barrowneuro.org/neurobiology/2060