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Neurosurgical Review

, Volume 36, Issue 3, pp 429–435 | Cite as

Surgical treatment of tentorial dural arteriovenous fistulae located around the tentorial incisura

  • Taketo Hatano
  • Oliver BozinovEmail author
  • Jan-Karl Burkhardt
  • Helmut Bertalanffy
Original Article

Abstract

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.

Keywords

Dural arteriovenous fistulae (DAVF) Microsurgery Tentorial incisura Treatment Subtemporal approach 

Notes

Disclosure

No funding or industrial financial support was received for this study.

Supplementary material

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)

References

  1. 1.
    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
  2. 2.
    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
  3. 3.
    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
  4. 4.
    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
  5. 5.
    Lewis AI, Rosenblatt SS, Tew JM Jr (1997) Surgical management of deep-seated dural arteriovenous malformations. J Neurosurg 87(2):198–206CrossRefPubMedGoogle Scholar
  6. 6.
    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
  7. 7.
    Kakarla UK, Deshmukh VR, Zabramski JM, Albuquerque FC, McDougall CG, Spetzler RF (2007) Surgical treatment of high-risk intracranial dural arteriovenous fistulae: clinical outcomes and avoidance of complications. Neurosurgery 61(3):447–457, discussion 457–449CrossRefPubMedGoogle Scholar
  8. 8.
    Zhou LF, Chen L, Song DL, Gu YX, Leng B (2007) Tentorial dural arteriovenous fistulas. Surg Neurol 67(5):472–481, discussion 481–472CrossRefPubMedGoogle Scholar
  9. 9.
    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
  10. 10.
    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
  11. 11.
    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
  12. 12.
    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
  13. 13.
    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
  14. 14.
    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
  15. 15.
    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

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Taketo Hatano
    • 1
  • Oliver Bozinov
    • 2
    Email author
  • Jan-Karl Burkhardt
    • 2
  • Helmut Bertalanffy
    • 3
  1. 1.Department of NeurosurgeryUniversity HospitalKyotoJapan
  2. 2.Department of NeurosurgeryUniversity Hospital ZürichZürichSwitzerland
  3. 3.Department of Neurosurgery, International Neuroscience InstituteHannoverGermany

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