Midline supracerebellar infratentorial approach with clip occlusion of a straight sinus dural arteriovenous fistula

Authors

Anna L. Huguenard, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Visish M. Srinivasan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Mohamed A. Labib, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Jakub Godzik, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Michael T. Lawton, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

Document Type

Article

Abstract

Straight sinus dural arteriovenous fistulas (dAVFs), classified as tentorial type 2, can be approached with a torcular craniotomy and supracerebellar infratentorial approach, with gravity retraction from a sitting position optimizing the view. This video presents the case of a man in his early 60s with a thunderclap headache. Imaging showed a subarachnoid hemorrhage, and angiography confirmed a straight sinus dAVF. Endovascular embolization reduced flow, but further obliteration with surgical ligation was required. Intraoperative identification of the arterialized veins led to the fistula, and 2 efferent veins were clipped and divided. The patient tolerated the procedure well without new deficits, and angiography confirmed dAVF occlusion. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2586.

Publication Date

10-1-2025

Publication Title

Neurosurgical focus: Video

E-ISSN

2643-5217

Volume

13

Issue

2

First Page

V10

PubMed ID

41113723

Digital Object Identifier (DOI)

10.3171/2025.7.FOCVID2586

Recommended Citation

Huguenard, Anna L.; Srinivasan, Visish M.; Labib, Mohamed A.; Godzik, Jakub; and Lawton, Michael T., "Midline supracerebellar infratentorial approach with clip occlusion of a straight sinus dural arteriovenous fistula" (2025). Neurosurgery. 2274.
https://scholar.barrowneuro.org/neurosurgery/2274