Medial Tentorial Dural Arteriovenous Fistula Embolization: Single Experience with Embolic Liquid Polymer SQUID and Review of the Literature

Andrea Gioppo, Giuseppe Faragò, Valentina Caldiera, Luigi Caputi, Alberto Cusin, Elisa Ciceri

Research output: Contribution to journalArticlepeer-review

Abstract

Background 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. We present a rare case of a medial tentorial DAVF successfully managed via transarterial embolization using SQUID liquid polymer. Case Description A 60-year-old woman presented with a history of left progressive hearing loss and tinnitus for >1 year. Cerebral angiography demonstrated the presence of a medial tentorial DAVF with multiple arterial feeders, including the artery of Davidoff and Schechter; reverse venous outflow was observed in the inferior sagittal sinus and in multiple cortical veins. The patient underwent transarterial embolization with SQUID liquid polymer, an embolic agent that provides 2 different viscous formulations to cast the DAVF. The procedure went well without any complication, and the patient regained her preoperative status. In the postprocedural period, the patient experienced complete resolution of tinnitus. At 6 months, she remained asymptomatic, and cerebral angiography confirmed complete, stable occlusion of the fistula and normalization of cerebral deep venous outflow. Conclusions Medial tentorial DAVFs are considered the most complex DAVFs because of their location and extensive vascular supply. Our literature review focused on endovascular treatment of tentorial DAVFs to highlight the usefulness of new embolic agents in management of these diseases. To our knowledge, we report the first successful use of SQUID liquid polymer in management of a tentorial DAVF.

Original languageEnglish
Pages (from-to)1050.e1-1050.e7
JournalWorld Neurosurgery
Volume107
DOIs
Publication statusPublished - Nov 1 2017

Keywords

  • Dural arteriovenous fistulas
  • Embolic agents
  • Embolization
  • Liquid embolic polymer
  • Tentorial

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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