What type of study is this?

This is a Experimental Study study.

October 2, 2025Open Access

Microsurgical obliteration of a superior petrosal dural arteriovenous fistula presenting with a symptomatic brainstem cavernous malformation

Puntos clave

The procedure achieved complete obliteration of the dural arteriovenous fistula with successful cavernoma resection, restoring neurological function.
Indocyanine green angiography detected cortical venous reflux, leading to reclassification of the fistula's complexity post-surgery.
Retrosigmoid craniotomy was performed to evacuate the cavernoma and disconnect the fistula successfully, showing robust outcomes.
This case illustrates the unusual co-occurrence of a dural arteriovenous fistula, a developmental venous anomaly, and a cavernous malformation.

Resumen

In this video, the authors present the microsurgical treatment of a superior petrosal dural arteriovenous fistula (dAVF) associated with a symptomatic hemorrhagic brainstem cavernous malformation in a 38-year-old male. The patient underwent a retrosigmoid craniotomy for cavernoma evacuation and fistula disconnection. Intraoperative indocyanine green angiography revealed cortical venous reflux not evident on catheter angiography, prompting reclassification to a higher-grade fistula. Postoperatively, the patient returned to neurological baseline, and follow-up imaging confirmed complete fistula obliteration, cavernoma resection, and new appearance of a developmental venous anomaly (DVA). This case highlights the dynamic nature of dAVF venous drainage and illustrates the rare co-occurrence of dAVF, DVA, and brainstem cavernoma. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2553

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