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Silvia Gesheva, William T. Couldwell, Vance Mortimer, Philipp Taussky and Ramesh Grandhi

Dural arteriovenous fistulae (dAVFs) are vascular anomalies formed by abnormal connections between branches of dural arteries and dural veins or dural venous sinus(es). These pathologic shunts constitute 10%–15% of all intracranial arteriovenous malformations. The hallmark of malignant dAVFs is the presence of cortical venous drainage, a finding that increases the likelihood of nonhemorrhagic neurologic deficit, intracranial hemorrhage, and mortality if left unaddressed. Endovascular approaches have become the primary modality for the treatment of dAVFs. The authors present a case of staged endovascular transarterial embolization of a malignant dAVF running parallel to the left transverse sinus in a patient with headaches and pulsatile tinnitus. The fistula was completely treated using Onyx and n-butyl cyanoacrylate.

The video can be found here: https://youtu.be/GSAto_wlC3I.

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Thomas J. Sorenson, Lucio De Maria, Leonardo Rangel-Castilla and Giuseppe Lanzino

Craniocervical junction dural arteriovenous fistulas (dAVFs) are rare vascular lesions with a potentially dangerous natural history due to the onset of neurological deficit secondary to intracranial hemorrhage or myelopathy due to venous congestion. Despite advances in endovascular techniques, many dAVFs located in this area continue to require surgical treatment as embolization is often not feasible or safe. In this video, the authors illustrate a patient with a symptomatic craniocervical junction dAVF who had undergone attempted Onyx embolization at another institution. Because of persistent filling of the fistula and worsening myelopathy after the previous attempt, the patient was referred to the authors’ clinic for definitive surgical treatment. The video illustrates the typical location of the early draining vein in most craniocervical junction dAVFs immediately below the emergence of the vertebral artery from the dura. The patient underwent successful definitive clip ligation of the fistula, which was exposed through a lateral suboccipital craniotomy.

The video can be found here: https://youtu.be/Bvg6VKLgwO0.

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Visish M. Srinivasan, Anish N. Sen and Peter Kan

The authors present a case of a patient with a Barrow Type B carotid-cavernous fistula (CCF) who presented with severe symptoms of eye redness, diplopia, and proptosis. Due to the tortuosity and size of her angular vein and the lack of good flow/access via the inferior petrosal sinus, she was treated with a transvenous approach via a large, dilated superior ophthalmic vein for coil embolization of the CCF. The patient had a full angiographic and symptomatic cure. The authors present the treatment plan and strategy and the fluoroscopic recording of the treatment. Nuances of the technique are discussed.

The video can be found here: https://youtu.be/ABkGm17-cBU.

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André Beer-Furlan, Hormuzdiyar H. Dasenbrock, Krishna C. Joshi and Michael Chen

Tentorial dural arteriovenous fistulas (DAVFs) are uncommon, complex fistulas located between the leaves of the tentorium cerebelli with a specific anatomic and clinical presentation characterized by high hemorrhagic risk. They have an extensive arterial supply and complex venous drainages, making them difficult to treat. There is recent literature favoring treatment through an endovascular transarterial route. The authors present an uncommon tentorial/ambient cistern region DAVF with feeders arising from the external and internal carotid arteries. The patient underwent a combined transarterial and transvenous approach with successful obliteration of the DAVF. The authors discuss the management challenges faced in this case.

The video can be found here: https://youtu.be/VXDD8zUvsSQ.