Tentorial dural arteriovenous fistulae (DAVF) are relatively uncommon and are the most dangerous type of DAVF. Because of a high incidence of hemorrhage and subsequent neurological deficits, treatment is mandatory. A consecutive series of nine surgically treated patients with symptomatic tentorial DAVF were analyzed in this study. All lesions were located around the tentorial incisura and were treated microsurgically using a subtemporal approach in eight cases and a supracerebellar approach in one case. The dural bases of the lesions were located adjacent to the tentorial edge in six patients and the tentorial apex in three patients. Complete obliteration was achieved in all treated tentorial DAVF. In one patient, the torcular fistula remained untreated without cortical venous reflux. Postoperative asymptomatic temporal lobe hemorrhage was diagnosed in one patient with a tentorial apex DAVF; however, no new neurological symptoms were present after surgical treatment. The subtemporal approach for unilateral tentorial DAVF is a favorable and direct approach for the highly skilled surgeon. Perimesencephalic venous dilatation or varix is an important finding on MRI to help localize tentorial DAVF in the tentorial edge or apex.
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No funding or industrial financial support was received for this study.
Supplemental Video 1
Video of patient 1 demonstrating the clipping of the DAVF draining vein via a subtemporal approach, 1:03 min, 20.2 MB. (MP4 5418 kb)
Supplemental Video 2
Video of patient 6 demonstrating clipping of the DAVF draining vein via a subtemporal approach, 2:43 min, 91.5 MB. (MP4 16587 kb)
Supplemental Video 3
Video of patient 7 demonstrating clipping of the DAVF draining vein via a subtemporal approach, 1:50 min, 34.5 MB. (MP4 10729 kb)
Cognard C, Gobin YP, Pierot L et al (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194(3):671–680PubMedGoogle Scholar
Awad IA, Little JR, Akarawi WP, Ahl J (1990) Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72(6):839–850CrossRefPubMedGoogle Scholar
Borden JA, Wu JK, Shucart WA (1995) A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg 82(2):166–179CrossRefPubMedGoogle Scholar
Lawton MT, Sanchez-Mejia RO, Pham D, Tan J, Halbach VV (2008) Tentorial dural arteriovenous fistulae: operative strategies and microsurgical results for six types. Neurosurgery 62(3 Suppl 1):110–124, discussion 124–115CrossRefPubMedGoogle Scholar
Lewis AI, Rosenblatt SS, Tew JM Jr (1997) Surgical management of deep-seated dural arteriovenous malformations. J Neurosurg 87(2):198–206CrossRefPubMedGoogle Scholar
Tomak PR, Cloft HJ, Kaga A, Cawley CM, Dion J, Barrow DL (2003) Evolution of the management of tentorial dural arteriovenous malformations. Neurosurgery 52(4):750–760, discussion 760–752CrossRefPubMedGoogle Scholar
Jiang C, Lv X, Li Y, Zhang J, Wu Z (2009) Endovascular treatment of high-risk tentorial dural arteriovenous fistulas: clinical outcomes. Neuroradiology 51(2):103–111CrossRefPubMedGoogle Scholar
Lucas CP, Zabramski JM, Spetzler RF, Jacobowitz R (1997) Treatment for intracranial dural arteriovenous malformations: a meta-analysis from the English language literature. Neurosurgery 40(6):1119–1130, discussion 1130–1112CrossRefPubMedGoogle Scholar
Davies MA, TerBrugge K, Willinsky R, Coyne T, Saleh J, Wallace MC (1977) The natural history and management of intracranial dural arteriovenous fistulae, part 2: aggressive lesions. Interv Neuroradiol 3:303–311Google Scholar
Collice M, D'Aliberti G, Arena O, Solaini C, Fontana RA, Talamonti G (2000) Surgical treatment of intracranial dural arteriovenous fistulae: role of venous drainage. Neurosurgery 47(1):56–66, discussion 66–57PubMedGoogle Scholar
Lucas CP, De Oliveira E, Tedeschi H et al (1996) Sinus skeletonization: a treatment for dural arteriovenous malformations of the tentorial apex. Report of two cases. J Neurosurg Mar 84(3):514–517CrossRefGoogle Scholar
Ulm AJ, Tanriover N, Kawashima M, Campero A, Bova FJ, Rhoton A Jr (2004) Microsurgical approaches to the perimesencephalic cisterns and related segments of the posterior cerebral artery: comparison using a novel application of image guidance. Neurosurgery 54(6):1313–1327, discussion 1327–1318CrossRefPubMedGoogle Scholar
Liu JK, Dogan A, Ellegala DB, Carlson J, Nesbit GM, Barnwell SL, Delashaw JB (2009) The role of surgery for high-grade intracranial dural arteriovenous fistulas: importance of obliteration of venous outflow. J Neurosurg 110(5):913–920CrossRefPubMedGoogle Scholar