Endovascular Treatment of Tentorial Dural Arteriovenous Fistulae

Abstract

<jats:p> Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which accounts for less than 4% of all cases of intracranial DAVF. Because of the high risk of intracranial hemorrhage, patients with tentorial DAVF need aggressive treatment. Management approaches are still controversial, and endovascular treatment has emerged as an effective alternative. In the current work, we describe our experience with the endovascular approach in the treatment of these deep and complex DAVF of the tentorium. </jats:p><jats:p> Eight patients were treated between January 2006 and July 2009. Six patients (75%) presented with intracranial hemorrhage related to the DAVF rupture. Four patients (50%) had subarachnoid bleeding and two had intraparenchymal hematoma. Endovascular treatment was performed via the transarterial route alone in five cases (62.5%), by the transvenous approach in two cases (25.0%) and in a combined procedure using both arterial and venous routes in one patient (12.5%). Complete obliteration of the fistula was achieved in all cases. The outcome at 15 months was favorable (modified Rankin scale 0–3) in seven (87.5%) patients. Complete cure of the lesion was confirmed in these cases. </jats:p><jats:p> This paper reports on the effectiveness of endovascular treatment in tentorial DAVF management. The choice of the venous versus the arterial approach is determined by regarding different anatomical dispositions. </jats:p>

Clinical importance of the middle meningeal artery: A review of the literature

“…DAVFs of the superior sagittal sinus are supplied by the temporal branch, parietal branch, and frontal branch 18 . DAVFs of the transverse, sigmoid sinus and tentorium are supplied by the petrosquamosal branch, temporal branch, or parietal branch 19 , 20 . Sometimes, when the branches of the MMA that are involved in the DAVF are not the main feeding arteries, the MMA may still be chosen as the route to access the DAVF 21 .…”

Tentorial Dural Fistulas: Endovascular Management and Description of the Medial Dural-Tentorial Branch of the Superior Cerebellar Artery

“…1,2 The TDAVF is a rare subgroup, constituting Ͻ4% of DAVFs. 1,[3][4][5][6] TDAVFs are most frequently diagnosed in middle-aged men, 2,4,5,7 unlike DAVFs elsewhere, which are more frequent in elderly women. 8,9 Spontaneous intracranial hemorrhage is the usual presenting symptom because cortical venous reflux is common.…”

Direct access to the middle meningeal artery for embolization of complex dural arteriovenous fistula: a hybrid treatment approach

“…Endovascular embolization is frequently considered first-line treatment for DAVF. Successful clinical and angiographic outcomes are routinely reported following embolization 4 5 7 8. However, uncertainty exists with respect to treatment via a transarterial or a transvenous embolization technique.…”