Advertisement

Acta Neurologica Belgica

, Volume 119, Issue 1, pp 5–14 | Cite as

Current status of endovascular treatment for dural arteriovenous fistulae in the tentorial middle region: a literature review

  • Dan Tong
  • Xuan Chen
  • Xianli Lv
  • Kailing Li
  • Kan Xu
  • Jinlu YuEmail author
Review Article

Abstract

The tentorial middle region (TMR) includes the midline and paramedian tentorium. TMR dural arteriovenous fistulae (DAVFs) are complex. We performed a review of the literature on TMR DAVFs. TMR DAVFs are divided into the following four types: incisural DAVF, Galenic DAVF, straight sinus DAVF and torcular DAVF. TMR DAVFs often drain into pial veins; therefore, most TMR DAVFs are classified as Borden II–III and Cognard types IIb–IV, whose characteristics cause TMR DAVFs to be prone to hemorrhage. TMR DAVFs have a very disappointing natural progression, and treatment is necessary. TMR DAVFs have extensive arterial supply and complex venous drainages, making them difficult to treat. Currently, for TMR DAVF, endovascular treatment (EVT) has become a better option. In EVT, transarterial embolization is the first-line treatment. Many complications can occur when treating TMR DAVFs, but complete EVT can generally achieve good clinical outcomes. In this review, three educational cases with demonstrating figures are provided to elaborate TMR DAVFs.

Keywords

Tentorial middle region Dural arteriovenous fistula Endovascular treatment Review 

Introduction

Tentorial dural arteriovenous fistulae (DAVFs) are located on the tentorium and can extend from their attachment to the clinoid processes and petrous ridges anteriorly to the torcula posteriorly [1, 2]. Tentorial DAVFs can be divided into marginal, lateral, and medial subtypes [3]. The medial subtype tentorial DAVFs are located in the tentorial middle region (TMR), including the midline and paramedian tentorium, and should be called TMR DAVFs [3, 4].

Compared with marginal and lateral subtype tentorial DAVFs, TMR DAVFs have a deeper midline location, more complex angioarchitecture and critical neuroanatomies. These DAVFs are different from the other tentorial DAVFs and are difficult to understand. Therefore, it is imperative to discuss TMR DAVFs separately from the other tentorial DAVFs. The natural progression of TMR DAVFs is very disappointing. Therefore, TMR DAVFs should be treated [5].

Currently, endovascular treatment (EVT) has become a better option for TMR DAVFs than radiotherapy and surgery [1, 6, 7]. For TMR DAVFs, surgical treatment is difficult due to the deep location and complex structures [3, 8]. Radiotherapy is usually not solely used in TMR DAVFs because of the risk of hemorrhage between treatment and occlusion [9, 10]. Currently, a comprehensive review of TMR DAVFs is lacking. In this study, we performed a literature review of TMR DAVFs. In addition, three educational cases with example figures are provided.

Critical vessels in the TMR

Arterial supply

The arterial supply to the TMR DAVFs includes the middle meningeal artery (MMA) [11, 12]; the medial tentorial artery (MTA) [4, 13, 14, 15, 16, 17, 18, 19]; the meningeal branch of occipital artery (OA) [11, 12]; the posterior meningeal artery (PMA) [20]; the tentorial branches of the posterior cerebral artery (PCA), which is also called the artery of Davidoff and Schechter (ADS); and the superior cerebellar artery (SCA), which is also called the artery of Wollschlaeger and Wollschlaeger [3, 21, 22, 23].

Venous drainage

The main venous drainages for TMR DAVFs include the vein of Galen, the internal cerebral vein (ICV), the basal vein (BV) of Rosenthal, the straight sinus (SS), the cerebral and cerebellar cortical veins (CVs), and the lateral mesencephalic vein (LMV) as well as spinal venous drainage [3, 8, 24, 25, 26, 27, 28]. The LMV is important in TMR DAVFs because it connects the infratentorial and supratentorial compartments and joins the BV of Rosenthal and the petrosal system [29]. The LMV is involved in the venous drainage of 31% of tentorial DAVFs [30].

TMR DAVF classification

TMR DAVFs can be categorized into the following four types according to Lawton et al. [3], Lasjaunias et al. [31] and Picard et al. [32].

Incisural DAVFs

Incisural DAVFs are located along the free edge of the tentorium [2, 33, 34]. Their main feeding arteries include the MMA and MTA [3, 4, 8, 16]. The draining veins of incisural DAVFs are not clearly associated with a venous sinus, with drainage occurring supratentorially into the medial and inferior temporal veins, into the BV of Rosenthal and LMVs in the ambient cistern, or even via cervical perimedullary venous drainage [3, 8, 16, 19, 35].

Galenic DAVFs

Galenic DAVFs are located at the midline of the posterior margin of the tentorial incisura [3, 4]. Their feeding arteries enter inferiorly from the ADS, anteriorly from the MTA, superiorly from the MMA/falcine artery, and posteriorly from the PMA [3, 4, 30]. The venous drainage of Galenic DAVFs can be supratentorial, infratentorial, or both and include the vein of Galen, the BV of Rosenthal, CVs, and mesencephalic veins [3, 5, 30, 36].

SS DAVFs

SS DAVFs are located at the falcotentorial junction [37]. Their main feeding arteries include the PMA, the MTA, the MMA, and the meningeal branch of the OA [3, 4]. SS DAVFs infratentorially drain into the vermian or superior cerebellar veins; when the SS is occluded, the venous drainage is redirected into the vein of Galen or its tributaries [3, 38, 39].

Tentorial sinus DAVFs are also included in the SS DAVF classification; they share similar feeding arteries and draining veins [3].

Torcular DAVFs

Torcular DAVFs are located at the midline of the posterior margin of the falcotentorial junction [5]. Their main feeding arteries include the PMA, MMA, MTA and ADS [3, 4, 5]. Torcular DAVFs drain supratentorially into the medial and inferior occipital veins along the sagittal and transverse sinuses or the BV of Rosenthal [5]. All torcular DAVFs are associated with sinus thrombosis and show bidirectional drainage relative to the tentorium [23].

Falx cerebelli and superior sagittal sinus DAVFs that are close to torcular herophili are also classified as torcular DAVFs; they share similar feeding arteries and draining veins [40].

The classification of TMR DAVFs is shown in Fig. 1.

Fig. 1

TMR DAVF Classification. a, b TMR DAVFs can be categorized into four types. ① is an incisural DAVF, ② is a Galenic DAVF, ③ is a straight sinus DAVF, and ④ is a torcular DAVF. TMR tentorial meningeal region, DAVF dural arteriovenous fistula

Angioarchitecture and grading

Angioarchitecture

When TMR DAVFs are supplied, some small branches may become hypertrophic and amenable to catheterization [19, 36, 38, 41, 42]. TMR DAVFs frequently have retrograde drainage through CVs and deep drainage through the vein of Galen, which causes hemorrhage, bilateral thalamic venous hypertension, or the perimedullary venous plexus [35, 43, 44, 45]. The draining vein may become variceal due to the high flow [1, 39, 46]. Even more rarely, the draining vein can dilate into a giant venous ampulla, causing mass effects [46, 47].

Borden and Cognard grades

Retrograde CV drainage is very common in TMR DAVFs [3, 48]. Therefore, most TMR DAVFs are classified as Borden II-III [16, 49] and Cognard IIb-IV [50, 51]. For example, in 2008, Lawton et al. examined 31 cases, of which 26 (84%) had Borden III DAVFs and five (16%) had Borden II DAVFs [3]. In another study (Tomak et al., 2003) with 22 tentorial DAVFs, all cases were classified as Borden type III [35]. Therefore, TMR DAVFs have the most aggressive neurological behavior, with 97% of cases causing hemorrhage or progressive focal neurological deficits [39, 52].

Outline of EVT

TMR DAVFs often drain exclusively to CVs. Advancing a microcatheter through the elongated, ecstatic, and fragile pial veins is considered quite difficult and risky, which prevents transvenous embolization (TVE); therefore, transarterial embolization (TAE) is the first-line treatment [1, 38, 39]. The embolic agents include coils, liquid embolic agents (Onyx; Micro Therapeutics Inc., Irvine, CA) and n-butyl cyanoacrylate (NBCA) (Histoacryl, Yocan Medical, Toronto, CA), or both in combination [5, 8].

If there is a single feeding artery, TAE is simple; even placing a coil in the origin of the tentorial artery may close the fistula [8]. However, most TMR DAVFs have multiple feeding arteries, making individual catheterization quite difficult. Thus, identifying the most suitable feeder choice is very important. This choice should be based on the tortuosity, diameter and length of the feeding artery as well as the distance between the microcatheter tip and the fistula; it is recommended that the microcatheter tip be positioned at or immediately adjacent to the fistula [39].

During TAE, the goal is the penetration of the liquid embolic agents to all fistula points and proximal venous outflows to ensure complete embolization. Meanwhile, the TAE must preserve the patency of the vein of Galen and the SS to avoid symptomatic venous hypertension. Sometimes, selective transarterial or transvenous occlusion of the draining vein should also be the goal of EVT, when occlusion of the cortical vein or part of a nonfunctional sinus guarantees definitive occlusion of the fistula [8].

TVE may be attempted if occlusion of the fistula point of TMR DAVFs is not achieved using TAE or if venous access to the fistula is simple [48, 53]. TVE with coils is the best treatment option [9]. For example, in Deasy et al. (1999), two TMR DAVFs were treated successfully with transvenous coil embolization via the internal jugular vein and the SS [54]. In addition, TAE and TVE can be combined, but the combination is uncommon [1, 23, 48, 53, 55].

For simple TMR DAVFs, complete obliteration should be easy to achieve, but for some complex and malignant DAVFs, it is difficult to achieve 100% obliteration; thus, the next goal is to reduce the blood flow to and pressure on the TMR DAVFs [53]. Patients with these DAVFs should be controlled by DSA and, after eventual hypertrophy of the residual feeders, either the EVT should be reattempted or radiosurgery should be proposed.

Paths of TAE

Theoretically, any feeding artery can be used as the path for TAE, but MMA is the best path choice in TMR DAVFs; occasionally, other arteries can be chosen [11, 38, 48, 56].

MMA path

The MMA has unique characteristics in that it is straight and fixed between the dura. Therefore, the MMA is commonly used to access TMR DAVFs. All MMA branches can be used to access a DAVF [3, 4]. Furthermore, when a DAVF occurs, the MMA often becomes thicker than normal as a result of hemodynamic stress [11]. Even if the branches of the MMA are not the main feeders, the MMA may represent the safest route to access the TMR DAVF because the MMA allows a long reflux [1, 7, 38, 57]. Sometimes, using a dual-lumen balloon to perform the TAE may be very useful [58].

Case 1 (Fig. 2) and case 2 (Fig. 3) were treated via MMA and achieved complete embolization.

Fig. 2

TMR DAVF images of typical case 1. Case 1 was a 54-year-old female patient with headache. a DSA of the right ECA shows that the MMA and perforators of the ECA supply the DAVF; the venous drainage is the dilated Galen vein. The asterisk shows the planned MMA path to embolize the DAVF. b DSA of the right ICA shows a dilated MTA to supply the DAVF. c The microcatheter in MMA is shown (arrows). d The Onyx casting is shown in the DAVF. e, f DSA of the right common carotid artery shows the complete embolization of the DAVF. TMR tentorial middle region, DAVF dural arteriovenous fistula, DSA digital subtraction angiography, ECA external carotid artery, MMA middle meningeal artery, ICA internal carotid artery, MTA medial tentorial artery

Fig. 3

TMR DAVF images of typical case 2. Case 2 was a 52-year-old male patient with intracranial hematoma. a DSA of the left ECA shows that the MMA and the meningeal branch of OA supply the DAVF and that venous drainage is via the LMV to the vein of Galen. b 3D-DSA of the left ICA shows a dilated MTA (asterisk). c 3D-DSA of the left VA shows the major AICA and SCA (asterisks) that distally supply the DAVF probably by meningeal or pial branches. The artery of Wollschlaeger and Wollschlaeger is not the feeding artery and is not visible. d The Onyx casting is shown in the DAVF by the left MMA path to embolize the DAVF (asterisk). bf DSA of the left VA and ICA shows the complete embolization of the DAVF. TMR tentorial middle region, DAVF dural arteriovenous fistula, DSA digital subtraction angiography, ECA external carotid artery, MMA middle meningeal artery, OA occipital artery, LMV lateral mesencephalic vein, MTA medial tentorial artery, VA vertebral artery, AICA anterior inferior cerebellar artery, SCA superior cerebellar artery

Other paths

In TMR DAVFs, the OA can be a good feeding artery; the enlarged meningeal branch of the OA allows the microcatheter to deliver liquid embolic agent [3, 5, 33, 39]. Kim et al. (2015) treated a torcular DAVF; the carefully selected catheterization of the transosseous meningeal branch of the OA was successful in providing the microcatheter with access to the fistula point, then Onyx was injected, filling the retrograde drainage of the CV and obliterating the DAVF [5].

Case 3 (Fig. 4) was treated via the OA and obtained complete embolization.

Fig. 4

TMR DAVF images of typical case 3. Case 3 was a 56-year-old female patient with subarachnoid hemorrhage. She had undergone Onyx embolization of a TMR DAVF 10 years previously. a DSA of the left VA shows that the meningeal branch of AICA with two aneurysms (asterisk) supplies the DAVF. b DSA of the left ICA shows a dilated MTA; some Onyx was casted in the MTA 10 years ago. c DSA of the left ECA shows that the meningeal branch of the OA (asterisk) supplies the DAVF and that venous drainage is via the LMV to the vein of Galen. d The Onyx casting is shown in the DAVF by the OA path to embolize the DAVF; e, f DSA of the left ICA and VA shows the complete embolization of the DAVF. TMR tentorial middle region, DAVF dural arteriovenous fistula, DSA digital subtraction angiography, VA vertebral artery, AICA anterior inferior cerebellar artery, ICA internal carotid artery, MTA medial tentorial artery, ECA external carotid artery, OA occipital artery, LMV lateral mesencephalic vein

However, if the MMA or OA is not available, then the MTA, ADS, ascending pharyngeal artery (APhA) and PMA can be used to perform TAE [8, 39]. However, these arteries can be used only as auxiliary arterial paths because the use of TAE via these feeders to the TMR DAVFs will result in incomplete occlusion with residual filling [1, 47].

Complications

TMR DAVFs are difficult to manage, and many complications can occur during EVT [1]. In patients treated with EVT, the rate of complications is 13.5%, and these complications include intraoperative hemorrhage, postoperative ischemia and cranial nerve palsy [38].

Intracranial hemorrhage

Vessel perforation by microwire and feeding artery rupture because of microcatheter removal during TAE can result in intraoperative hemorrhage [57, 59]. During or after TAE, spontaneous hemorrhage can be disastrous, this complication may be secondary to restriction of the venous outlet, which can result in venous hypertension; then, the venous varix ruptures [59].

In addition, Wu et al. (2016) found that pial arterial supply may be a risk factor for intracranial hemorrhage during TAE of DAVF through dural feeders; these authors advised that obliterating pial feeding arteries—at least the major ones—before fistula embolization through dural feeders may decrease the risk of hemorrhage [57].

In fact, these pial arteries are not appropriate to first embolize the TMR DAVFs, as suggested by Wu et al. Because these pial arteries are fragile and easy to rupture, the allowed reflux distance is not sufficient to ensure a safe reflux of Onyx during the creation of the plug; it is difficult to push Onyx into the DAVF. Moreover, Onyx can easily flow into the ICA and VA.

Cranial nerve palsy

Cranial nerve palsy during TAE occurs when the embolizing liquid embolic agent migrates to the nerve-supplying artery [60]. In TMR DAVFs, the oculomotor and trochlear nerves may derive blood supply from the MTA; occlusion of the MTA can result in palsy of these nerves [33, 61, 62].

The facial nerve is divided into three topographical segments: the labyrinthine, tympanic and mastoid segments. The geniculate ganglion is located between the labyrinthine and tympanic segments. The tympanic segment and geniculate ganglion are vascularized by the petrosal artery from the MMA [63]. When embolizing TMR DAVFs from the posterior MMA branch, it is critical to avoid any reflux into the petrosal branch, which supplies the facial nerve [7]. Embolization may compromise the circulation through the petrosal branch and thus cause the facial nerve palsy.

Therefore, it is critical to fully understand the vascular supply to the cranial nerves and the potentially dangerous anastomoses.

Brain infarction

When performing TAE, if the pial arteries are chosen as embolizing arteries, reflux can block the normal artery, and brain infarction can occur [38]. Zhang et al. (2010) treated two TMR DAVFs via the PCA and SCA; postoperative cerebellar infarction associated with dorsal pons to mesencephalic infarcts occurred [56]. The TMR DAVF in case 2 (Fig. 3) was supplied by the SCA and AICA; in case 3 (Fig. 4), the DAVF was supplied by the AICA. A long duration of Onyx reflux in these pial arteries will result in brain infarction, even the occlusion of VA; so, these pial arteries cannot be chosen to be first embolized.

Catheter retention

During TAE for TMR DAVFs, prolonged injection times and excessive reflux were the primary reasons for Marathon flow-guided microcatheter (Micro Therapeutics Inc., Irvine, CA) retention [62]. If the arterial feeders are too tortuous, long and tiny, the difficulty of removing the catheter will increase. When Onyx reflux occurs for too long, retrieval by applying too much traction on an entrapped catheter may increase the risk of vessel rupture [1]. Therefore, it may be safer to leave the microcatheter in the vascular system. For fear of thromboembolic events, in these cases, a daily dose of 100 mg of aspirin should be administered orally for 3 months [39].

Because of the limitations of Marathon microcatheter retention, considerable interest has been expressed in the development of detachable-tip microcatheters. Currently. detachable-tip microcatheters mainly included the SONIC (Balt, Montmorency, France) and Apollo (Micro Therapeutics Inc., Irvine, CA) Onyx delivery microcatheters [64], which allow for more controlled and longer injections and better DAVF penetration with minimized risk of microcatheter retention. Therefore, catheter retention may no longer be an issue.

Other complications

In addition to the above complications, other complications can occur, such as trigeminocardiac reflex [1], venous rupture [45], draining vein thrombosis [47], and microcatheter rupture [23]. During TAE, the liquid embolic agent can cross the fistula point into the ICA or VA though a feeding artery of the TMR DAVF. In these cases, a balloon placed in the ICA or VA is recommended [45].

Prognosis

After EVT, TMR DAVFs require angiographic follow-up because the immediate “angiographic cure” does not mean complete embolization of TMR DAVFs; moreover, after complete embolization, TMR DAVFs can recur [39, 53].

However, the follow-up interval was uncertain. In the Liu et al. (2014) study of 26 tentorial DAVFs, all patients underwent follow-up with DSA at 3 months after EVT [62]. In the Wu et al. (2018) study of 6 TMR DAVFs, the angiographic follow-up was from 4 to 12 months [57]. Our DSA follow-up time was at approximately 6 months. In TMR DAVFs with partial occlusion, the follow-up interval should be shorter, especially if the retrograde drainage of the CV was not obliterated completely.

Generally, the EVT of tentorial DAVFs yields a good outcome. Gioppo et al. (2017) performed a review of 72 tentorial DAVFs, in which 92.5% were treated via TAE. Complete obliteration was achieved in 86.1% of cases. The rate of clinical improvement was approximately 88.8% [38]. The prognosis of TMR DAVFs may be worse than that of general tentorial DAVFs because the obliteration rate was 66.7% in the TMR DAVFs [38, 62].

The outcome of EVT of TMR DAVFs was acceptable. The clinical outcome of TMR DAVFs at follow-up should be evaluated using a neurological functional scale such as the modified Rankin Scale (mRS); unfortunately, some studies report a subjective “resolution of symptoms”, “complete cure”, or “excellent/good” outcome status [38]. This review recommends the use of the mRS.

For TMR DAVFs, if complete obliteration is impossible, it is necessary to decrease the Borden and Cognard grades, and the retrograde drainage through CVs must be corrected [62]. If the retrograde drainage of CVs is not obliterated, a staged TAE via another feeding artery may be attempted again [1]. If repeated EVT still cannot obliterate the retrograde drainage of CVs, combined surgical removal or radiotherapy can be attempted [3, 4, 33, 34, 65, 66, 67, 68].

Currently, DSA is still the gold standard for monitoring TMR DAVF to exclude recurrence or persisting DAVFs; however, with the development of magnetic resonance imaging (MRI) and MR angiography (MRA), including 3D time-of-flight MRA [69] and 3D or 4D contrast-enhanced MRA [70, 71], these data can be used to monitor DAVFs. MRI and MRA can visualize the cortical draining veins and usually the arterial feeders before embolization, indicating a Grade II or III TMR DAVF. Therefore, MRI and MRA can be used for late-term follow-up to determine whether the cortical draining vein disappears or reappears if conservative treatment is adopted. However, their value in follow-up imaging is limited.

Summary

TMR DAVFs have a very disappointing natural progression. Treatment is difficult because of their extensive arterial supply and complex venous drainages. TMR DAVFs often drain into pial veins and are generally classified as Borden II–III and Cognard IIb–IV and are thus prone to hemorrhage. Currently, EVT has become a better option for TMR DAVFs, among which TAE has become the first-line treatment option. For the path of TAE, MMA is the best choice. Occasionally, TVE alone or combined with TAE may be attempted. TMR DAVFs are difficult to cure, and many complications can occur. Generally, the EVT of TMR DAVFs yields a good outcome.

Notes

Acknowledgements

We would like to acknowledge the reviewers for their helpful comments on this paper.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest.

Ethical approval

This work is a review of the literature and did not require ethical approval to be carried out.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    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):103–111.  https://doi.org/10.1007/s00234-008-0473-8 Google Scholar
  2. 2.
    Zhou LF, Chen L, Song DL, Gu YX, Leng B (2007) Tentorial dural arteriovenous fistulas. Surg Neurol 67(5):472–481.  https://doi.org/10.1016/j.surneu.2006.08.078 discussion 481 – 472.Google Scholar
  3. 3.
    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.  https://doi.org/10.1227/01.neu.0000317381.68561.b0 discussion 124 – 115.Google Scholar
  4. 4.
    Martins C, Yasuda A, Campero A, Ulm AJ, Tanriover N, Rhoton A (2005) Microsurgical anatomy of the dural arteries. Neurosurgery 56(2 Suppl):211–251; (discussion 211–251) Google Scholar
  5. 5.
    Kim HJ, Yang JH, Lee HJ, Lee HJ (2015) Tentorial Dural Arteriovenous Fistula Treated Using Transarterial Onyx Embolization. J Korean Neurosurg Soc 58(3):276–280.  https://doi.org/10.3340/jkns.2015.58.3.276 Google Scholar
  6. 6.
    Choudhri O, Marks MP (2014) Endovascular treatment of a tentorial dural arteriovenous fistula. Neurosurg Focus 37(1 Suppl):1.  https://doi.org/10.3171/2014.V2.FOCUS14184 Google Scholar
  7. 7.
    Puffer RC, Daniels DJ, Kallmes DF, Cloft HJ, Lanzino G (2012) Curative Onyx embolization of tentorial dural arteriovenous fistulas. Neurosurg Focus 32(5):E4.  https://doi.org/10.3171/2011.12.FOCUS11323 Google Scholar
  8. 8.
    van Rooij WJ, Sluzewski M, Beute GN (2006) Tentorial artery embolization in tentorial dural arteriovenous fistulas. Neuroradiology 48(10):737–743.  https://doi.org/10.1007/s00234-006-0118-8 Google Scholar
  9. 9.
    Pichierri A, Delfini R (2012) Incisural and superior petrous dural arteriovenous fistulas: a contemporary perspective. World Neurosurg 77(3–4):472–474.  https://doi.org/10.1016/j.wneu.2011.10.014 Google Scholar
  10. 10.
    Matsushige T, Nakaoka M, Ohta K, Yahara K, Okamoto H, Kurisu K (2006) Tentorial dural arteriovenous malformation manifesting as trigeminal neuralgia treated by stereotactic radiosurgery: A case report. Surg Neurol 66(5):519–523.  https://doi.org/10.1016/j.surneu.2006.01.022 (discussion 523).Google Scholar
  11. 11.
    Yu J, Guo Y, Xu B, Xu K (2016) Clinical importance of the middle meningeal artery: A review of the literature. Int J Med Sci 13(10):790–799.  https://doi.org/10.7150/ijms.16489 Google Scholar
  12. 12.
    Yu J, Guo Y, Wu Z, Xu K (2017) Traumatic arteriovenous fistula between the extracranial middle meningeal artery and the pterygoid plexus: A case report and literature review. Interv Neuroradiol 23(1):90–96.  https://doi.org/10.1177/1591019916673584 Google Scholar
  13. 13.
    Reisch R, Vutskits L, Patonay L, Fries G (1996) The meningohypophyseal trunk and its blood supply to different intracranial structures. An anatomical study. Minim Invasive Neurosurg 39(3):78–81.  https://doi.org/10.1055/s-2008-1052222 Google Scholar
  14. 14.
    Inoue T, Rhoton AL, Theele D, Barry ME (1990) Surgical approaches to the cavernous sinus: a microsurgical study. Neurosurgery 26(6):903–932Google Scholar
  15. 15.
    Lasjaunias PL (1984) Anatomy of the tentorial arteries. J Neurosurg 61(6):1159–1160Google Scholar
  16. 16.
    Hatano T, Bozinov O, Burkhardt JK, Bertalanffy H (2013) Surgical treatment of tentorial dural arteriovenous fistulae located around the tentorial incisura. Neurosurg Rev 36(3):429–435.  https://doi.org/10.1007/s10143-013-0448-z Google Scholar
  17. 17.
    Tubbs RS, Nguyen HS, Shoja MM, Benninger B, Loukas M, Cohen-Gadol AA (2011) The medial tentorial artery of Bernasconi-Cassinari: a comprehensive review of its anatomy and neurosurgical importance. Acta Neurochir (Wien) 153(12):2485–2490.  https://doi.org/10.1007/s00701-011-1195-y Google Scholar
  18. 18.
    Peltier J, Fichten A, Havet E, Foulon P, Page C, Le Gars D (2010) Microsurgical anatomy of the medial tentorial artery of Bernasconi-Cassinari. Surg Radiol Anat 32(10):919–925.  https://doi.org/10.1007/s00276-010-0655-z Google Scholar
  19. 19.
    Liu S, Lee DC, Tanoura T (2016) Tentorial dural arteriovenous fistula of the medial tentorial artery. Radiol Case Rep 11(3):242–244.  https://doi.org/10.1016/j.radcr.2016.06.006 Google Scholar
  20. 20.
    Shukla V, Hayman LA, Ly C, Fuller G, Taber KH (2002) Adult cranial dura I: intrinsic vessels. J Comput Assist Tomogr 26(6):1069–1074Google Scholar
  21. 21.
    Tayebi Meybodi A, Vigo V, Lawton MT, Benet A (2017) The artery of Wollschlaeger and Wollschlaeger: an anatomical-clinical illustration. Br J Neurosurg 31(5):593–595.  https://doi.org/10.1080/02688697.2017.1333573 Google Scholar
  22. 22.
    Griessenauer CJ, Loukas M, Scott JA, Tubbs RS, Cohen-Gadol AA (2013) The artery of Davidoff and Schechter: an anatomical study with neurosurgical case correlates. Br J Neurosurg 27(6):815–818.  https://doi.org/10.3109/02688697.2013.798856 Google Scholar
  23. 23.
    Byrne JV, Garcia M (2013) Tentorial dural fistulas: endovascular management and description of the medial dural-tentorial branch of the superior cerebellar artery. Am J Neuroradiol 34(9):1798–1804.  https://doi.org/10.3174/ajnr.A3519 Google Scholar
  24. 24.
    Singh D, Garg A, Gupta A, Goel G, Gupta R, Bansal A (2013) Tentorial dural arteriovenous fistula presenting as episodic weakness mimicking periodic paralysis. J Neurointerv Surg 5(5):e32.  https://doi.org/10.1136/neurintsurg-2012-010281 Google Scholar
  25. 25.
    Panagiotopoulos V, Kastrup O, Wanke I (2009) Endovascular treatment resolves non-hemorrhagic brainstem dysfunction due to tentorial dural AV fistula. J Clin Neurosci 16(2):317–320.  https://doi.org/10.1016/j.jocn.2008.02.022 Google Scholar
  26. 26.
    Khan S, Polston DW, Shields RW, Rasmussen P, Gupta R (2009) Tentorial dural arteriovenous fistula presenting with quadriparesis: case report and review of the literature. J Stroke Cerebrovasc Dis 18(6):428–434.  https://doi.org/10.1016/j.jstrokecerebrovasdis.2008.12.007 Google Scholar
  27. 27.
    Pannu Y, Shownkeen H, Nockels RP, Origitano TC (2004) Obliteration of a tentorial dural arteriovenous fistula causing spinal cord myelopathy using the cranio-orbito zygomatic approach. Surg Neurol 62(5):463–467.  https://doi.org/10.1016/j.surneu.2004.01.017 (discussion 467).Google Scholar
  28. 28.
    Benndorf G, Schmidt S, Sollmann WP, Kroppenstedt SN (2003) Tentorial dural arteriovenous fistula presenting with various visual symptoms related to anterior and posterior visual pathway dysfunction: case report. Neurosurgery 53(1):222–226; (discussion 226–227)Google Scholar
  29. 29.
    Ardeshiri A, Ardeshiri A, Tonn JC, Winkler PA (2006) Microsurgical anatomy of the lateral mesencephalic vein and its meaning for the deep venous outflow of the brain. Neurosurg Rev 29(2):154–158.  https://doi.org/10.1007/s10143-005-0016-2 (discussion 158).Google Scholar
  30. 30.
    Cannizzaro D, Rammos SK, Peschillo S, El-Nashar AM, Grande AW, Lanzino G (2016) The lateral mesencephalic vein: surgical anatomy and its role in the drainage of tentorial dural arteriovenous fistulae. World Neurosurg 85:163–168.  https://doi.org/10.1016/j.wneu.2015.08.060 Google Scholar
  31. 31.
    Lasjaunias P, Chiu M, ter Brugge K, Tolia A, Hurth M, Bernstein M (1986) Neurological manifestations of intracranial dural arteriovenous malformations. J Neurosurg 64(5):724–730.  https://doi.org/10.3171/jns.1986.64.5.0724 Google Scholar
  32. 32.
    Picard L, Bracard S, Islak C, Roy D, Moreno A, Marchal JC, Roland J (1990) Dural fistulae of the tentorium cerebelli. Radioanatomical, clinical and therapeutic considerations. J Neuroradiol 17(3):161–181Google Scholar
  33. 33.
    Mariniello G, Briganti F, Vergara P, Maiuri F (2012) Dural tentorial arteriovenous fistula causing isolated trochlear nerve palsy: remission after endovascular embolization. J Neurointerv Surg 4(3):e5.  https://doi.org/10.1136/neurintsurg-2011-010043 Google Scholar
  34. 34.
    van Lindert E, Hassler W, Kuhne D, Henkes H (2000) Combined endovascular-microsurgical treatment of tentorial-incisural dural arteriovenous malformations. Report of five cases. Minim Invasive Neurosurg 43(3):138–143.  https://doi.org/10.1055/s-2000-8334 Google Scholar
  35. 35.
    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 760–752)Google Scholar
  36. 36.
    Weil AG, McLaughlin N, Denis D, Bojanowski MW (2011) Tentorial branch of the superior cerebellar artery. Surg Neurol Int 2:71.  https://doi.org/10.4103/2152-7806.81733 Google Scholar
  37. 37.
    Zink WE, Meyers PM, Connolly ES, Lavine SD (2004) Combined surgical and endovascular management of a complex posttraumatic dural arteriovenous fistula of the tentorium and straight sinus. J Neuroimaging 14(3):273–276.  https://doi.org/10.1177/1051228404265371 Google Scholar
  38. 38.
    Gioppo A, Farago G, Caldiera V, Caputi L, Cusin A, Ciceri E (2017) Medial Tentorial Dural Arteriovenous Fistula Embolization: Single Experience with Embolic Liquid Polymer SQUID and Review of the Literature. World Neurosurg 107:1050.  https://doi.org/10.1016/j.wneu.2017.08.050 Google Scholar
  39. 39.
    Huang Q, Xu Y, Hong B, Li Q, Zhao W, Liu J (2009) Use of onyx in the management of tentorial dural arteriovenous fistulae. Neurosurgery 65(2):287–292.  https://doi.org/10.1227/01.NEU.0000348298.75128.D0 (discussion 292–283).Google Scholar
  40. 40.
    Minamide H, Hayashi Y, Uchiyama N (2017) Multiple tentorial dural arteriovenous fistulas with acquired pial arteriovenous fistula presented with unilateral eye symptoms successfully treated by transarterial embolization and direct surgery: a case report. No Shinkei Geka 45(3):239–245.  https://doi.org/10.11477/mf.1436203486 Google Scholar
  41. 41.
    Umeoka K, Takusakawa Y, Kominami S, Kobayashi S, Morita A (2016) The meningeal branches of the superior cerebellar artery: a surgical observation study. J Neurosurg 124(1):244–247.  https://doi.org/10.3171/2014.12.JNS141190 Google Scholar
  42. 42.
    Deshmukh VR, Maughan PH, Spetzler RF (2006) Resolution of hemifacial spasm after surgical obliteration of a tentorial arteriovenous fistula: case report. Neurosurgery 58(1):E202; (discussion E202)Google Scholar
  43. 43.
    Alvarez H, Sasaki-Adams D, Castillo M (2015) Resolution of brainstem edema after treatment of a dural tentorial arteriovenous fistula. Interv Neuroradiol 21(5):603–608.  https://doi.org/10.1177/1591019915591741 Google Scholar
  44. 44.
    Gross R, Ali R, Kole M, Dorbeistein C, Jayaraman MV, Khan M (2014) Tentorial dural arteriovenous fistula presenting as myelopathy: Case series and review of literature. World J Clin Cases 2(12):907–911.  https://doi.org/10.12998/wjcc.v2.i12.907 Google Scholar
  45. 45.
    Santillan A, Safdieh JE, Gobin YP, Patsalides A (2011) Neurological picture. Bilateral thalamic venous hypertension caused by a tentorial dural arteriovenous fistula: endovascular treatment. J Neurol Neurosurg Psychiatry 82(7):749–750.  https://doi.org/10.1136/jnnp.2010.231969 Google Scholar
  46. 46.
    Iwamuro Y, Nakahara I, Higashi T, Iwaasa M, Watanabe Y, Hirata E, Tsunetoshi K, Taha M (2006) Tentorial dural arteriovenous fistula presenting symptoms due to mass effect on the dilated draining vein: case report. Surg Neurol 65(5):511–515.  https://doi.org/10.1016/j.surneu.2005.07.076 Google Scholar
  47. 47.
    Borha A, Emery E, Courtheoux P, Lefevre P, Derlon JM (2010) Tentorial dural fistula with giant venous ampulae treated with embolisation and surgery. A case report. Acta Neurochir (Wien) 152(10):1745–1753.  https://doi.org/10.1007/s00701-010-0722-6 Google Scholar
  48. 48.
    Wajnberg E, Spilberg G, Rezende MT, Abud DG, Kessler I, Mounayer C, Association of Rothschild Foundation A (2012) Endovascular treatment of tentorial dural arteriovenous fistulae. Interv Neuroradiol 18(1):60–68.  https://doi.org/10.1177/159101991201800108 Google Scholar
  49. 49.
    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):166–179.  https://doi.org/10.3171/jns.1995.82.2.0166 Google Scholar
  50. 50.
    Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, Chiras J, Merland JJ (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194(3):671–680.  https://doi.org/10.1148/radiology.194.3.7862961 Google Scholar
  51. 51.
    Gomez J, Amin AG, Gregg L, Gailloud P (2012) Classification schemes of cranial dural arteriovenous fistulas. Neurosurg Clin N Am 23(1):55–62.  https://doi.org/10.1016/j.nec.2011.09.003 Google Scholar
  52. 52.
    Awad IA, Little JR, Akarawi WP, Ahl J (1990) Intracranial dural arteriovenous malformations: factors predisposing to an aggressive neurological course. J Neurosurg 72(6):839–850.  https://doi.org/10.3171/jns.1990.72.6.0839 Google Scholar
  53. 53.
    Gross BA, Ducruet AF, Jankowitz BT, Gardner PA (2017) An Intraoperative Look at a Residual/Recurrent Tentorial Dural Arteriovenous Fistula. World Neurosurg.  https://doi.org/10.1016/j.wneu.2017.07.015 Google Scholar
  54. 54.
    Deasy NP, Gholkar AR, Cox TC, Jeffree MA (1999) Tentorial dural arteriovenous fistulae: endovascular treatment with transvenous coil embolisation. Neuroradiology 41(4):308–312Google Scholar
  55. 55.
    Troffkin NA, Graham CB, Berkmen T, Wakhloo AK (2003) Combined transvenous and transarterial embolization of a tentorial-incisural dural arteriovenous malformation followed by primary stent placement in the associated stenotic straight sinus. Case report. J Neurosurg 99(3):579–583.  https://doi.org/10.3171/jns.2003.99.3.0579 Google Scholar
  56. 56.
    Zhang J, Lv X, Jiang C, Li Y, Wu Z (2010) Superior cerebellar artery infarction in endovascular treatment for tentorial dural arteriovenous fistulas. Eur J Radiol 74(3):e33–e37.  https://doi.org/10.1016/j.ejrad.2009.03.048 Google Scholar
  57. 57.
    Wu Q, Zhang XS, Wang HD, Zhang QR, Wen LL, Hang CH, Zhang X (2016) Onyx Embolization for Tentorial Dural Arteriovenous Fistula with Pial Arterial Supply: Case Series and Analysis of Complications. World Neurosurg 92:58–64.  https://doi.org/10.1016/j.wneu.2016.04.033 Google Scholar
  58. 58.
    Kim ST, Jeong HW, Seo J (2013) Onyx Embolization of Dural Arteriovenous Fistula, using Scepter C Balloon Catheter: a Case Report. Neurointervention 8(2):110–114.  https://doi.org/10.5469/neuroint.2013.8.2.110 Google Scholar
  59. 59.
    Sato K, Matsumoto Y, Endo H, Tominaga T (2017) A hemorrhagic complication after Onyx embolization of a tentorial dural arteriovenous fistula: a caution about subdural extension with pial arterial supply. Interv Neuroradiol 23(3):307–312.  https://doi.org/10.1177/1591019917694839 Google Scholar
  60. 60.
    Geibprasert S, Pongpech S, Armstrong D, Krings T (2009) Dangerous extracranial-intracranial anastomoses and supply to the cranial nerves: vessels the neurointerventionalist needs to know. Am J Neuroradiol 30(8):1459–1468.  https://doi.org/10.3174/ajnr.A1500 Google Scholar
  61. 61.
    van Rooij WJ, Sluzewski M, Slob MJ, Rinkel GJ (2005) Predictive value of angiographic testing for tolerance to therapeutic occlusion of the carotid artery. Am J Neuroradiol 26(1):175–178Google Scholar
  62. 62.
    Liu C, Xu B, Song D, Leng B, Mao Y, Gu Y, Liao Y (2014) Clinical approach of using Onyx via transarterial access in treating tentorial dural arteriovenous fistula. Neurol Res 36(11):983–991.  https://doi.org/10.1179/1743132814Y.0000000383 Google Scholar
  63. 63.
    Dozic A, Cetkovic M, Marinkovic S, Mitrovic D, Grujicic M, Micovic M, Milisavljevic M (2014) Vascularisation of the geniculate ganglion. Folia Morphol (Warsz) 73(4):414–421.  https://doi.org/10.5603/FM.2014.0063 Google Scholar
  64. 64.
    Flores BC, See AP, Weiner GM, Jankowitz BT, Ducruet AF, Albuquerque FC (2018) Use of the Apollo detachable-tip microcatheter for endovascular embolization of arteriovenous malformations and arteriovenous fistulas. J Neurosurg.  https://doi.org/10.3171/2017.9.JNS17397 Google Scholar
  65. 65.
    Gross BA, Ropper AE, Popp AJ, Du R (2012) Stereotactic radiosurgery for cerebral dural arteriovenous fistulas. Neurosurg Focus 32(5):E18.  https://doi.org/10.3171/2012.1.FOCUS11354 Google Scholar
  66. 66.
    Lewis AI, Tomsick TA, Tew JM (1994) Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery. J Neurosurg 81(6):851–859.  https://doi.org/10.3171/jns.1994.81.6.0851 Google Scholar
  67. 67.
    Morparia N, Miller G, Rabinstein A, Lanzino G, Kumar N (2012) Cognitive decline and hypersomnolence: thalamic manifestations of a tentorial dural arteriovenous fistula (dAVF). Neurocrit Care 17(3):429–433.  https://doi.org/10.1007/s12028-012-9746-5 Google Scholar
  68. 68.
    Shin M, Kurita H, Tago M, Kirino T (2000) Stereotactic radiosurgery for tentorial dural arteriovenous fistulae draining into the vein of Galen: report of two cases. Neurosurgery 46(3):730–733; (discussion 733–734)Google Scholar
  69. 69.
    Azuma M, Hirai T, Shigematsu Y, Kitajima M, Kai Y, Yano S, Nakamura H, Makino K, Iryo Y, Yamashita Y (2015) Evaluation of intracranial dural arteriovenous fistulas: comparison of unenhanced 3T 3D time-of-flight MR angiography with digital subtraction angiography. Magn Reson Med Sci 14(4):285–293.  https://doi.org/10.2463/mrms.2014-0120 Google Scholar
  70. 70.
    Meckel S, Maier M, Ruiz DS, Yilmaz H, Scheffler K, Radue EW, Wetzel SG (2007) MR angiography of dural arteriovenous fistulas: diagnosis and follow-up after treatment using a time-resolved 3D contrast-enhanced technique. Am J Neuroradiol 28(5):877–884Google Scholar
  71. 71.
    Nishimura S, Hirai T, Sasao A, Kitajima M, Morioka M, Kai Y, Omori Y, Okuda T, Murakami R, Fukuoka H, Awai K, Kuratsu JI, Yamashita Y (2010) Evaluation of dural arteriovenous fistulas with 4D contrast-enhanced MR angiography at 3T. Am J Neuroradiol 31(1):80–85.  https://doi.org/10.3174/ajnr.A1898 Google Scholar

Copyright information

© Belgian Neurological Society 2018

Authors and Affiliations

  1. 1.Department of RadiologyThe First Hospital of Jilin UniversityChangchunChina
  2. 2.Department of NeurosurgeryThe First Hospital of Jilin UniversityChangchunChina
  3. 3.Department of Neurosurgery, Beijing Tsinghua Changgung HospitalTsinghua UniversityBeijingChina

Personalised recommendations