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This is a Case Report study (also classified as: Experimental Study).

October 2, 2025Open Access

Type V tentorial dural arteriovenous fistula: a case of augmented reality–assisted surgical salvage

Key Points

Surgical intervention improved brainstem edema and symptoms post-embolization failure.
Initial embolization was unsuccessful for the Cognard type V fistula, leading to augmented reality surgery.
The procedure involved identifying and ligating arterialized veins using advanced imaging techniques.
Postoperative imaging revealed significant improvement in the patient's condition with reduced venous hypertension.

Abstract

This video demonstrates the case of a Cognard type V tentorial dural arteriovenous fistula that was successfully salvaged using augmented reality–assisted microsurgery following failed endovascular embolization. The patient had a spastic gait and quadrilateral numbness. MRI showed medullary edema and abnormal vessels near the tentorium. DSA confirmed a shunt fed by the meningohypophyseal trunk draining into perimedullary veins. Initial embolization was unsuccessful. Using CISS MRI and augmented reality projection, the authors identified and ligated the arterialized veins, relieving venous hypertension. Postoperative imaging showed improvement of the brainstem edema. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2541

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