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This is a Human Clinical Trial study.

October 2, 2025Open Access

Staged transarterial and transvenous embolization of a high-grade ruptured tentorial dural arteriovenous fistula

Key Points

Transvenous coiling achieved complete cure of a high-grade TDAVF in a 77-year-old woman after initial failure.
Angiography confirmed no further arteriovenous shunting postoperatively, indicating successful intervention.
Staged embolization technique demonstrated to be effective in managing complex angioarchitecture of the lesion.
Follow-up imaging revealed neurologically stable status and no signs of complications from the procedure.

Abstract

Tentorial dural arteriovenous fistulas (TDAVFs) are rare but high-risk lesions due to frequent deep venous drainage. A 77-year-old woman presented with a ruptured, high-grade (Borden III, Cognard IV, Zipfel 3S) TDAVF at the pontomesencephalic junction. Angiography revealed feeders from the left middle meningeal artery, occipital artery, and meningohypophyseal trunk with tortuous venous drainage into a partially thrombosed varix. Initial transarterial N -butyl cyanoacrylate ( N -BCA) embolization was incomplete. Definitive cure was achieved with transvenous coiling. Postoperatively, the patient was neurologically stable, and follow-up angiography revealed no further arteriovenous shunting, demonstrating how staged embolization can lead to curing TDAVFs with complex angioarchitecture. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2593

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