Nuances of transarterial and transvenous embolization of a large tentorial arteriovenous fistula

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An 80-year-old female presented with a long history of severe pulsatile tinnitus, vertigo, and decreased hearing. She was found to have a large right-sided tentorial arteriovenous fistula (AVF) with enlarged deep draining veins, including the vein of Rosenthal. The patient underwent Onyx embolization of the fistula via a combined transarterial and transvenous approach resulting in complete obliteration of the fistula. Her symptoms improved immediately after the procedure and at 6-months’ follow-up she was clinically asymptomatic with no evidence of residual fistula on neuroimaging. Transvenous embolization of AVF is at times necessary when transarterial access is not possible.

The video can be found here: https://youtu.be/uOMHY7eaOoQ.

An 80-year-old female presented with a long history of severe pulsatile tinnitus, vertigo, and decreased hearing. She was found to have a large right-sided tentorial arteriovenous fistula (AVF) with enlarged deep draining veins, including the vein of Rosenthal. The patient underwent Onyx embolization of the fistula via a combined transarterial and transvenous approach resulting in complete obliteration of the fistula. Her symptoms improved immediately after the procedure and at 6-months’ follow-up she was clinically asymptomatic with no evidence of residual fistula on neuroimaging. Transvenous embolization of AVF is at times necessary when transarterial access is not possible.

The video can be found here: https://youtu.be/uOMHY7eaOoQ.

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Article Information

CORRESPONDENCE Leonardo Rangel-Castilla, Mayo Clinic, Rochester, MN. RangelCastilla.Leonardo@mayo.edu.

INCLUDE WHEN CITING Published online April 1, 2019; DOI: http://thejns.org/doi/abs/10.3171/2019.2.FocusVid.18674.

DISCLOSURES The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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