What does this research mean for the field?

High-grade tentorial dural arteriovenous fistulas (Cognard type IV) can masquerade as aneurysmal Sylvian subarachnoid hemorrhage and can be definitively cured with prompt microsurgical disconnection. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

Describe the clinical presentation, diagnostic challenges, and microsurgical management of a high-grade tentorial dural arteriovenous fistula mimicking an aneurysmal subarachnoid hemorrhage.

August 15, 2026Asian Journal of Neurosurgery

Ruptured High-Grade Tentorial Dural Arteriovenous Fistula Masquerading as Aneurysmal Sylvian Subarachnoid Hemorrhage: A Diagnostic Pitfall

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Authors

ACAbinash ChihnaraUtkal University SSSidhartha Shankar SahooUtkal University

Discussion

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Implication

Case report demonstrates successful microsurgical obliteration of a ruptured tentorial dural fistula in a 54-year-old male, highlighting digital subtraction angiography for accurate diagnosis.

Key Points

Describe the clinical presentation, diagnostic challenges, and microsurgical management of a high-grade tentorial dural arteriovenous fistula mimicking an aneurysmal subarachnoid hemorrhage.
Evaluated a 54-year-old male presenting with acute headache, confusion, expressive aphasia, and right hemiparesis using CT, CT angiography, and digital subtraction angiography (DSA).
Performed an urgent left frontotemporal craniotomy with microsurgical disconnection and coagulation of feeding arteries alongside excision of the ectatic draining vein.
Digital subtraction angiography confirmed a Cognard type IV tentorial dural arteriovenous fistula fed by external carotid branches with an ectatic draining cortical vein.
Postoperative angiography demonstrated complete fistula obliteration, leading to steady neurological recovery and full resolution of expressive aphasia over several weeks.

Cite This Study

Chihnara et al. (2026) studied this question.

synapsesocial.com/papers/6a801a0e75c2e31742c8668d https://doi.org/10.1055/s-0046-1827477

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Implication

Case report demonstrates successful microsurgical obliteration of a ruptured tentorial dural fistula in a 54-year-old male, highlighting digital subtraction angiography for accurate diagnosis.

Ruptured High-Grade Tentorial Dural Arteriovenous Fistula Masquerading as Aneurysmal Sylvian Subarachnoid Hemorrhage: A Diagnostic Pitfall

Discussion

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Implication

Key Points

Cite This Study

Ruptured High-Grade Tentorial Dural Arteriovenous Fistula Masquerading as Aneurysmal Sylvian Subarachnoid Hemorrhage: A Diagnostic Pitfall

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Implication

Key Points

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