The microsurgical management of a brainstem compression resulted from an embolized cerebral tentorial dural arteriovenous fistula

Abstract

Intracranial dural arteriovenous fistulas (DAVFs) are abnormal connections between an arterial feeder and a dural venous sinus or leptomeningeal vein with the nidus located within the dural leaflets. In this article we report an uncommon event which is a hematoma inside a dilated draining vein formed after embolization of tentorial DAVF causing pressure on the brain stem and removed surgically. A 47 years old male with a history of ventriculoperitonial (V-P) shunt 2 years ago and embolization of arteriovenous malformation 15 years ago, presented to our hospital having symptoms due to tentorial dural arteriovenous fistula (TDAVF) fed from branches of external and internal carotid arteries. Two sessions of transarterial embolization were performed with total occlusion. Six months later, he was admitted to the hospital with gait unsteadiness, swallowing difficulties and confusion. Brain MRI revealed a hyperintense heterogenous mass like a pouch from thrombosed draining veins with a localized hematoma compressing the brainstem and causing these symptoms. A small hematoma was seen and removed microsurgically. The patient was improved clinically and was discharged home after 5 days. Neurointerventionalist must be aware when deciding to occlude TDAVMs as there is a risk of venous varix formation and rupture if incompletely occluded. Surgical intervention is sometimes needed to alleviate the hazardous compression on the brain stem and other vital structures. © 202