A tentorial dural arteriovenous fistula successfully treated with interruption of leptomeningeal venous drainage using microvascular doppler sonography: Case report

Abstract

BACKGROUND Complete interruption of a dural arteriovenous fistula (DAVF) has been confirmed intraoperatively by visual inspection and intraoperative angiography. To confirm complete interruption of the shunt flow during the surgical treatment of a tentorial DAVF, we used intraoperative microvascular doppler monitoring. CASE DESCRIPTION A 71-year-old man suffered from severe subarachnoid hemorrhage. Angiography showed a tentorial DAVF with pure leptomeningeal drainage associated with a venous pouch. After the patient’s neurologic condition had improved, he underwent interruption of the draining vein via a right suboccipital approach. An arterialized drainage vein was easily identified by applying the microvascular doppler probe to the shunting vessels and was completely obliterated by clipping. There were no complications associated with use of the microvascular doppler. The postoperative course was uneventful and follow-up angiography showed complete obliteration of the DAVF. CONCLUSION Intraoperative microvascular doppler monitoring is a useful technique not only for evaluating arterialized leptomeningeal drainage veins but also for confirming the complete obliteration of these vessels.