scholarly journals Endovascular Treatment of Medial Tentorial Dural Arteriovenous Fistula Through the Dural Branch of the Pial Artery

2021 ◽  
Vol 12 ◽  
Author(s):  
Chan-Lin Chu ◽  
Yu-Cheng Chu ◽  
Chee-Tat Lam ◽  
Tsong-Hai Lee ◽  
Shih-Chao Chien ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Brain Magnetic Resonance Imaging ◽  
Superior Cerebellar Artery ◽  
Key Factors ◽  
Pial Arteries ◽  
Pial Artery ◽  
Cerebellar Artery ◽  
Ischemic Complications ◽  
Midbrain Infarct

Background: Tentorial dural arteriovenous fistula is a rare subtype of intracranial dural arteriovenous fistula (DAVF) with a deteriorating natural course, which may be attributed to its pial angioarchitecture. TDAVF often harbors feeders arising from pial arteries (FPAs). Reports have revealed that, if these feeders are not obliterated early, the restricted venous outflow during the embolization process may cause upstream congestion in the fragile pial network, which increases the risk of hemorrhagic complications. Because most reported cases of TDAVF were embolized through feeders from non-pial arteries (FNPAs), little is known of the feasibility of direct embolization through FPAs.Methods: We present three patients with medial TDAVFs that were embolized through the dural branches of the posterior cerebral and superior cerebellar arteries. Findings from brain magnetic resonance imaging, computed tomography, angiography, and clinical outcomes are described. Furthermore, we performed a review of the literature on TDAVFs with FPAs.Results: The fistulas were completely obliterated in two patients; both recovered well with no procedure-related complications. The fistula was nearly obliterated in one patient, who developed left superior cerebellum and midbrain infarct due to the reflux of the embolizer into the left superior cerebellar artery. Including our cases, eight cases of TDAVFs with direct embolization through the FPAs have been reported, and ischemic complications occurred in three (37.5%).Conclusions: Advancing microcatheter tips as close to the fistula point as possible and remaining highly aware of potential embolizer flow back into the pial artery are key factors in achieving successful embolization. Balloon-assisted embolization may be an option for treating TDAVFs with FPAs in the future.

Rupture of an Aneurysm of the Superior Cerebellar Artery Feeding a Dural Arteriovenous Fistula

2015 ◽  
Vol 24 (5) ◽  
pp. e105-e107 ◽  
Author(s):  
Shinya Kohyama ◽  
Fumitaka Yamane ◽  
Hideaki Ishihara ◽  
Nahoko Uemiya ◽  
Shoichiro Ishihara
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery

scholarly journals Multiple aneurysms on the subarcuate artery arising from the anterior inferior cerebellar artery in a patient with a Borden type I transverse-sigmoid dural arteriovenous fistula manifesting as subarachnoid hemorrhage: A case report

2018 ◽  
Vol 25 (1) ◽  
pp. 90-96 ◽  
Author(s):  
Tomoaki Suzuki ◽  
Kouichirou Okamoto ◽  
Nobuyuki Genkai ◽  
Yasushi Ito ◽  
Hiroshi Abe
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Anterior Inferior Cerebellar Artery ◽  
Type I ◽  
Feeding Artery ◽  
Multiple Aneurysms ◽  
Arteriovenous Shunts ◽  
Cerebellar Artery ◽  
Subarcuate Artery

Background Peripheral anterior inferior cerebellar artery (AICA) aneurysms are rare and commonly associated with vascular malformations, such as cerebellar arteriovenous malformations (AVMs). We present a case wherein multiple AICA feeding aneurysms on the subarcuate artery as a feeding artery of a Borden type I transverse-sigmoid dural arteriovenous fistula (dAVF) manifested as subarachnoid hemorrhage. Case description A 67-year-old woman presented with acute severe headache. Brain computed tomography (CT) demonstrated subarachnoid hemorrhage mainly in the posterior fossa. A transverse-sigmoid dAVF was detected on magnetic resonance angiography (MRA) and three-dimensional-CT angiography (3D-CTA), with no cortical venous reflex. The patient underwent conventional angiography, which showed multiple aneurysms on a small branch of the AICA, feeding a transverse-sigmoid dAVF (Borden type I). The AICA aneurysms seemed flow dependent and ruptured owing to high-flow arteriovenous shunts through the dAVF. Based on the source images of the MRA, the small artery arising from the AICA was considered the subarcuate artery, and it was confirmed on 3D-CTA after the artery was successfully embolized with Onyx without any complications. Multiple aneurysms on the subarcuate artery are extremely rare, and the artery has not been identified as a feeding artery of the transverse-sigmoid dAVF. Conclusion A rare case of multiple ruptured aneurysms on the subarcuate artery was reported in a patient with a Borden type I dAVF at the transverse-sigmoid sinuses manifesting as subarachnoid hemorrhage. Onyx embolization of the parent artery occlusion was feasible and useful in treating this type of feeding artery aneurysm of the AICA with a dAVF.

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

2018 ◽  
Vol 80 (S 03) ◽  
pp. S333-S334
Author(s):  
Javier Ros de San Pedro ◽  
Beatriz Cuartero-Pérez
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
External Carotid Artery ◽  
Retrosigmoid Approach ◽  
Medical Attention ◽  
External Carotid ◽  
Anterior Inferior Cerebellar Artery ◽  
Surgical Clipping ◽  
Cerebellar Artery ◽  
Magnetic Resonance Imaging Mri

Objectives To demonstrate the surgical clipping of a lateral petrosal tentorial dural arteriovenous fistula (DAVF), located in the cerebellopontine angle (CPA), through a retrosigmoid approach. Method A previously healthy 49-year-old man presented a sudden episode of headache, photophobia, and dizziness. Due to the persistence of his symptoms despite proper analgesic treatment, he sought medical attention. The initial computed tomography (CT) scan showed a hyperdense lesion in the left CPA. Magnetic resonance imaging (MRI) demonstrated the vascular nature of the lesion, corresponding to an engorged superior petrosal vein (SPV) and Rosenthal's vein. The preoperative angiography showed a lateral tentorial DAVF (Lawton's type 5), fed by multiple transpetrous branches coming off the external carotid artery, and draining into the SPV. A standard retrosigmoid approach was planned for clipping and exclusion of the DAVF. Results Through a left retrosigmoid craniotomy the DAVF was approached, along with the different neurovascular structures of the CPA. The DAVF originated at the tentorial petrosal junction. The fistulous vein was closely attached to the trigeminal nerve and the anterior inferior cerebellar artery (AICA). The fistulous vein was dissected and clipped close to its base at the lateral tentorium, achieving complete occlusion of the DAVF. The patient fully recovered after surgery with neither relapse of his symptoms nor postoperative complications. Conclusion The retrosigmoid craniotomy is the best surgical approach for lateral tentorial DAVFs, as it provides a direct way to the fistula origin and permits a successful clipping of the draining vein.The link to the video can be found at: https://youtu.be/Fj3uqrTPX5c.

Embolism in the Superior Cerebellar Artery following Coil Embolization of Basilar Tip Aneurysms: Anatomy and Hemodynamics

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 165-172
Author(s):  
S. Miyachi ◽  
M. Negoro ◽  
M. Bundo ◽  
T. Okamoto ◽  
J. Yoshida
Keyword(s):  
Basilar Artery ◽  
Coil Embolization ◽  
Type A ◽  
Superior Cerebellar Artery ◽  
Plastic Tube ◽  
Coagulation Therapy ◽  
Cerebellar Artery ◽  
Ischemic Complications ◽  
Type C ◽  
Basilar Tip Aneurysm

We aimed to identify anatomic factors favoring intra-aneurysmal clot embolization complicating coil embolization of basilar tip aneurysms. Thirty basilar tip aneurysm cases were classified angiographically into three types according to branching pattern of the superior cerebellar artery (SCA) and coil embolization complications were analyzed. The SCA may arise from the basilar artery (BA) just proximal to the origin of the posterior cerebral artery (PCA), initially coursing at an angle (more than 60°) relative to the BA, (type A). Alternatively the SCA may originate directly from the PCA at a sharp angle less than 30° relative to the BA (type C). Type B includes patterns intermediate between types A and C. Behavior of particles chosen to simulate intra-aneurysmal clots was also observed in a plastic tube model with pulsatile water flow simulating configurations A and C. Type C branching was seen in 35% (21/60) of SCA, being dominant on the left side and associated with large aneurysms and broad necks. All 3 of 24 coil embolization patients with ischemic complications in the SCA territory had large aneurysms and type C SCA branching, 2 aneurysms having broad necks. In the plastic model embolized “clots” more frequently lodged in type C than in type A SCA. “Clots” close to the orifice migrated more easily than those in the dome of the plastic aneurysm. Large basilar tip aneurysms with broad necks carry a risk of intra-aneurysmal clot migration into the SCA, during and after the embolization, especially in type C configurations, because pulsatile blood flow in the basilar artery may disperse clots between the coils and carry them into the sharply angulated SCA. Avoiding this complication requires meticulous coil packing to interrupt inflow into the aneurysm as well as appropriate anti-coagulation therapy.

scholarly journals Complex spinal arteriovenous fistula of the craniocervical junction with pial and dural shunts combined with contralateral dural arteriovenous fistula

2015 ◽  
Vol 21 (6) ◽  
pp. 733-737 ◽  
Author(s):  
Jin Pyeong Jeon ◽  
Young Dae Cho ◽  
Chi Heon Kim ◽  
Moon Hee Han
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Craniocervical Junction ◽  
Pial Arteries ◽  
Spinal Arteriovenous Fistula ◽  
High Cervical

A high cervical dural arteriovenous fistula (dAVF) is relatively rare and tends to have different features, as compared with a thoracolumbar dAVF. Here, we report a case involving a complex AVF located at the craniocervical junction that was fed by the dural and pial arteries, combined with a contralateral dAVF.

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