Tentorial Dural Arteriovenous Fistula with Cerebellar Venous Congestion and Hemorrhage: Combined Transarterial Embolization with nBCA/Lipiodol and PHIL with Complete Occlusion of the Fistula in a Single Session and Good Clinical Outcome

Abstract

A 66-year-old female presented with vertigo, nausea, and vomiting. MRI revealed a varix in the vermis cerebelli and a small adjacent hemorrhage. DSA showed a tentorial dural arteriovenous fistula (DAVF) of the torcula, supplied by both occipital arteries, a dural branch of the left superior cerebellar artery, and the left middle meningeal artery. The venous drainage was via congestive cerebellar veins with varix formation. The endovascular treatment started with the obliteration of the supply from both occipital arteries with nBCA embolization. The dural branch to the DAVF originating from the left superior cerebellar artery was catheterized to monitor the progressive obliteration of the DAVF with intermittent superselective runs. The obliteration of the fistula was eventually achieved by injecting PHIL through the left-hand middle meningeal artery. The fistulous point with the convergent feeding arteries was occluded without compromising the surrounding cerebellar venous drainage. The transarterial embolization of tentorial DAVFs at the torcula is the main topic of this chapter.