Medial Tentorial Dural Arteriovenous Fistulae Embolization: Single Experience With Embolic Liquid Polymer Squid And Review Of The Literature.

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Medial Tentorial Dural Arteriovenous Fistulae Embolization: Single Experience With Embolic Liquid Polymer Squid And Review Of The Literature.

World Neurosurg. 2017 Aug 18;:

Authors: Andrea G, Giuseppe F, Valentina C, Luigi C, Alberto C, Elisa C

Abstract
BACKGROUND: Tentorial dural arteriovenous fistulae (DAVF) are uncommon and complex fistulae located between the leaves of the tentorium cerebelli, with a specific anatomical and clinical presentation characterized by high hemorrhagic risk. We present a rare case of a medial tentorial DAVF successfully managed via a transarterial embolization utilizing Squid liquid polymer.
CASE DESCRIPTION: A 60-year-old woman presented to our Institution with a history of left progressive hearing loss and tinnitus for over a year. Cerebral angiography demonstrated the presence of a medial tentorial DAVF, with multiple arterial feeders, including the artery of Davidoff and Schechter; reverse venous outflow was observed in the inferior sagittal sinus and in multiples cortical veins. The patient underwent transarterial embolization with Squid liquid polymer, an embolic agent that provides two different viscous formulation to cast the DAVF. The procedure went well without any complication and the patient regained pre-operative status. In the post-procedural period, the patient referred a complete resolution of the tinnitus. At 6 months she remained asymptomatic and cerebral angiography confirmed the complete, stable occlusion of the fistula as well as normalization of her cerebral deep venous outflow.
CONCLUSION: Medial tentorial are considered the most complex DAVFs for their location and the extensive vascular supply. Literature review focused on the endovascular treatment of tentorial DAVFs highlight the usefulness of the new embolic agents in the management of these diseases. To our knowledge, this report represents the first successful reported experience in the management of a tentorial DAVF with Squid liquid polymer.

PMID: 28826865 [PubMed - as supplied by publisher]

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