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Published on: January 27, 2015
Tentorial dural arteriovenous fistulas
Liang-Fu Zhou1, Liang Chen, Dong-Lei Song
1Department of Neurosurgery, Shanghai Neurosurgical Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China. lfzhouc@online.sh.cn <lfzhouc@online.sh.cn>
Surgical Neurology
|April 21, 2007
Summary
Tentorial dural arteriovenous fistulas (TDAVFs) are dangerous vascular lesions. Prompt diagnosis and treatment, including surgery and embolization, lead to successful outcomes and patient recovery.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Neuroradiology
Background:
- Tentorial dural arteriovenous fistulas (TDAVFs) are rare but life-threatening vascular malformations.
- This study presents clinical experience with 5 TDAVF patients and reviews literature.
Purpose of the Study:
- To describe the clinical characteristics, diagnostic methods, and treatment outcomes of TDAVFs.
- To present the rationale behind the current management strategy for TDAVFs.
Main Methods:
- Retrospective review of 5 patients with TDAVFs treated at Huashan Hospital (June 2002-May 2003).
- Data included medical history, neuroimaging (MRI, DSA), surgical records, and follow-up.
- Patients were classified using the Borden system and surgical approaches were documented.
Main Results:
- 5 patients (3 female, 2 male; age 25-52) presented with SAH or progressive neurologic deficits.
- All TDAVFs were Borden type 3; 3 were marginal, 1 lateral, and 1 medial.
- Treatment involved preoperative embolization (3 patients) and craniotomy with fistula coagulation and venous drainage disconnection.
- Surgical approaches varied; all patients improved with no mortality or morbidity.
- Postoperative imaging confirmed obliteration or thrombosis; follow-up (2-3 years) showed no recurrence.
Conclusions:
- TDAVFs are aggressive lesions requiring prompt diagnosis and treatment.
- Goals include obliterating fistulas and/or leptomeningeal venous drainage.
- Microsurgery combined with endovascular intervention offers the best treatment outcomes.
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