Ｔｅｎｔｏｒｉａｌ Ｄｕｒａｌ Ａｒｔｅｒｉｏｖｅｎｏｕｓ Ｆｉｓｔｕｌａの血管内治療

Abstract

Tentorial dural arteriovenous fistula (AVF) is an aggressive lesion causing intracranial hemorrhage, venous infarction, and progressive neurological deficits because it drains only the leptomeningeal vein. Though treatment options include surgical interruption of the draining vein or excision, stereotactic radiosurgery, endovascular procedure, and a combination of these options, optimal treatment has not been established. We report on 5 patients with tentorial dural AVFs treated by endovascular procedures. One patient presented with a progressive neurological deficit, 1 with subarachnoid hemorrhage, 1 with venous infarction, and 2 patients were incidentally discovered. All patients were treated with transarterial embolization using NBCA (n-butyl cyanoacrylate). In 1 patient with high flow fistula, coils were placed in the varix before NBCA injection to prevent excessive migration of NBCA into the draining vein. Immediate complete obliteration was achieved in 1 patient. In 3 of 4 patients with residual shunt, complete obliteration was confirmed by follow-up angiography. Transarterial embolization using NBCA for tentorial dural AVF is safe and effective, and can be a treatment of choice.