Microsurgical treatment of tentorial dural fistulas causing thalamic venous hypertension: two illustrative sister cases

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This video is a presentation of technical tenets for the microsurgical clipping of a tentorial dural arteriovenous fistula presenting with thalamic venous hypertension. These cases are easily misdiagnosed and often supplied by the tentorial artery of Davidoff and Schecter. The cases shown in the video uniquely illustrate a supracerebellar infratentorial approach to identify and clip an arterialized tentorial vein utilizing intraoperative Doppler and fluorescein, with navigation and an intraoperative cerebral angiogram in a hybrid neuroangiography operative suite. Both patients were found to have thalamic edema on preoperative imaging, which significantly improved postoperatively.

The video can be found here: https://youtu.be/HmUO6Ye53QI.

This video is a presentation of technical tenets for the microsurgical clipping of a tentorial dural arteriovenous fistula presenting with thalamic venous hypertension. These cases are easily misdiagnosed and often supplied by the tentorial artery of Davidoff and Schecter. The cases shown in the video uniquely illustrate a supracerebellar infratentorial approach to identify and clip an arterialized tentorial vein utilizing intraoperative Doppler and fluorescein, with navigation and an intraoperative cerebral angiogram in a hybrid neuroangiography operative suite. Both patients were found to have thalamic edema on preoperative imaging, which significantly improved postoperatively.

The video can be found here: https://youtu.be/HmUO6Ye53QI.

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Article Information

CORRESPONDENCE Omar Choudhri, Penn Center for Cerebral Revascularization, Philadelphia, PA. Omar.Choudhri@uphs.upenn.edu.

INCLUDE WHEN CITING Published online April 1, 2019; DOI: http://thejns.org/doi/abs/10.3171/2019.2.FocusVid.18635.

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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