title: Endovascular treatment of tentorial dural arteriovenous fistulae.
abstract: Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which accounts for less than 4% of all cases of intracranial DAVF. Because of the high risk of intracranial hemorrhage, patients with tentorial DAVF need aggressive treatment. Management approaches are still controversial, and endovascular treatment has emerged as an effective alternative. In the current work, we describe our experience with the endovascular approach in the treatment of these deep and complex DAVF of the tentorium.  Eight patients were treated between January 2006 and July 2009. Six patients (75%) presented with intracranial hemorrhage related to the DAVF rupture. Four patients (50%) had subarachnoid bleeding and two had intraparenchymal hematoma. Endovascular treatment was performed via the transarterial route alone in five cases (62.5%), by the transvenous approach in two cases (25.0%) and in a combined procedure using both arterial and venous routes in one patient (12.5%). Complete obliteration of the fistula was achieved in all cases. The outcome at 15 months was favorable (modified Rankin scale 0-3) in seven (87.5%) patients. Complete cure of the lesion was confirmed in these cases. This paper reports on the effectiveness of endovascular treatment in tentorial DAVF management. The choice of the venous versus the arterial approach is determined by regarding different anatomical dispositions.
authors.affiliation: Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Brazil. eduardowj@gmail.com
authors.forename: E
authors.initials: E
authors.lastname: Wajnberg
authors.forename: G
authors.initials: G
authors.lastname: Spilberg
authors.forename: M T
authors.initials: MT
authors.lastname: Rezende
authors.forename: D G
authors.initials: DG
authors.lastname: Abud
authors.forename: I
authors.initials: I
authors.lastname: Kessler
authors.forename: C
authors.initials: C
authors.lastname: Mounayer
mesh_terms: D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies