Angiographic computed tomography with selective microcatheterization in delineating surgical anatomy in the case of a...

Intracranial dural arteriovenous fistulas (dAVFs) are commonly encountered in centers specializing in cerebrovascular diseases. Knowing the precise site of fistulous communication with the venous structures is essential in targeting the appropriate surgical or endovascular therapy once a decision to treat has been made. Such sites can usually be located with digital subtraction angiography alone. The authors describe a case in which localization was best performed using cone-beam volume CT in the angiography suite after selective microcatheterization of the feeding vessel and injection of a contrast agent in a dAVF related to the petrous temporal bone. Imaging studies showed the lesion was related to the inferior aspect of the tentorium, warranting a suboccipital surgical approach to treat the fistula.