Combined surgical and endovascular management of a complex posttraumatic dural arteriovenous fistula of the tentorium and straight sinus

Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging
Walter E ZinkSean D Lavine

Abstract

Diagnosis and management of a complex tentorial dural arteriovenous fistula (DAVF) of the straight sinus with vein of Galen aneurysmal dilatation is presented. A 65-year-old woman with remote history of cranial gunshot lapsed into coma after months of progressive neurological decline. Computed tomography brain scan showed cerebellar hemorrhage while arteriography demonstrated a complex arteriovenous fistula of an isolated straight sinus and tentorium with extensive arterial supply. First extracranial then intracranial arterial feeders to the fistula were occluded in separate procedures following initial presentation. Eleven days after presentation, an occipital burr-hole craniotomy was performed, the isolated straight sinus was cannulated under fluoroscopic guidance, and the fistula eradicated with multiple thrombogenic fibered platinum and Gugliemi detachable coils. Staged embolization now represents the standard of care for many complex DAVFs. A multi-disciplinary surgical and endovascular approach is a valuable combination to cure deep lesions with limited surgical or transvascular access.

Citations

Jul 4, 2007·Topics in Magnetic Resonance Imaging : TMRI·Diana P Rodriguez, Tina Young Poussaint
Mar 26, 2013·Journal of Neurointerventional Surgery·Alejandro M SpiottaAquilla S Turk
Aug 8, 2009·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Neeraja PenumetchaJ Tilak Ratnanather
Jan 17, 2014·Journal of Neurointerventional Surgery·Justin M CaplanJudy Huang
Aug 14, 2019·Neurology·Sarah H BerthLisa R Sun

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