J Korean Neurosurg Soc.  2015 Sep;58(3):276-280. 10.3340/jkns.2015.58.3.276.

Tentorial Dural Arteriovenous Fistula Treated Using Transarterial Onyx Embolization

• Kim HJ
• Yang JH
• Lee HJ
• Lee HJ

• KMID: 2191383
• DOI: http://doi.org/10.3340/jkns.2015.58.3.276

Abstract

Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which has high risk of intracranial hemorrhage. We present two cases of tentorial DAVF which were successfully treated with single trial of transarterial embolization using Onyx. We briefly reviewed the types of the tentorial DAVF and strategies of treatment.

Keyword

Dural arteriovenous fistula; Tentorium; Embolization

MeSH Terms

Central Nervous System Vascular Malformations*
Intracranial Hemorrhages
Vascular Diseases

Figure

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  Fig. 1 Case 1. Brain CT (A) and MR imaging (B and C) showed acute hemorrhage at 4th ventricle and left tectum of mid brain. Enhanced axial MR imaging (C) showed prominent vessels near the perimesencephalic cistern and tentorial leaflet (white arrows). Right external carotid angiogram demonstrated a DAVF around torcular fed by meningeal branch of ascending pharyngeal artery, transosseus branch of the right occipital artery and drained into cortical vein of left occiput (black arrow) and basal vein of Rosenthal (D and E). Post-embolization angiogram demonstrated Onyx occupying the retrograde drainage of cortical vein and obliteration of DAVF. Onyx was injected through the transosseus branch of the right occipital artery (arrowhead) (F and G : Right external carotid angiogram. H : Skull AP view).

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  Fig. 2 Case 2. Brain CT image showed a prominent and tortuous vascular structure around medial tentorium (arrow) (A). Brain MR image showed multiple fine vessel engorgements at both thalamic and putamen regions (B). Angiogram demonstrated recanalization and recruitment from right middle meningeal arteries (C) and left middle meningeal arteries (D and E). The retrograde leptomeningeal drain of infratentorial vermian vein showed dilated and saccular change (arrowhead). Vertebral angiogram also showed supply from posterior choroidal artery (F). After embolization of DAVF through the right middle meningeal artery using Onyx, multiple fistula points and common draining vein was occluded and DAVF was obliterated (G : Right external carotid angiogram. H : Left external carotid angiogram. I : Vertebral angiogram. J : Skull lateral view).

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