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Intraoperative angiography guided microsurgical clipping of dural arteriovenous fistulae between Bernasconi-Cassinari artery and Galen vein: Report of case and literature review.

Dural arteriovenous fistulas (DAVFs)are abnormal vascular connections between dural arteries and venous sinuses or cortical encephalic veins. These short circuits may be associated with intracranial ischemia or hemorrhage that derive from increased drainage of the venous sinuses or cortical venous hypertension, implicit in its pathophysiology. The’Gold standard’ technique for diagnosis is digital subtraction brain angiography; however, there are different imaging techniques that provide essential information for its characterization and classification. The Borden-Shucart system and the Cognard scale are the most widely used classification systems. Therapeutic strategies for its management include endovascular or surgical methods. In general terms, endovascular management has replaced surgical management in recent years, since it is associated with lower morbidity and mortality rate (mortality <9%) and a shorter hospital stay. Tentorial dural arteriovenous fistulas (TDAVFs) correspond to 4 to 8% ofall DAVFs and are the subtype with the highest risk of bleeding, which occurs in 38 to 74% of patients. This article describes the case of an adult patient with a TDAVF between the Bernasconi-Cassinari artery and the Galen vein associated with midbrain hemorrhage. The patient received microsurgical management guided by intraoperative angiography, obtaining complete occlusion of the fistulous defect without complications and with adequate postoperative evolution.

Rev. Chil. Neurocirugía 45: 241-245,2019

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