American Association of Neurological Surgeons | Nuances of transarterial and transvenous embolization of a large tentorial arteriovenous fistula @AANSNeurosurgery | Uploaded December 2019 | Updated October 2024, 1 day ago.
Lorenzo Rinaldo, MD, PhD,1 Waleed Brinjikji, MD,1,2 and Leonardo Rangel-Castilla, MD1,2

Departments of 1Neurosurgery and 2Radiology, Mayo Clinic, Rochester, Minnesota

An 80-year-old female presented with a long history of severe pulsatile tinnitus, vertigo, and decreased hearing. She was found to have a large right-sided tentorial arteriovenous fistula (AVF) with enlarged deep draining veins, including the vein of Rosenthal. The patient underwent Onyx embolization of the fistula via a combined transarterial and transvenous approach resulting in complete obliteration of the fistula. Her symptoms improved immediately after the procedure and at 6-months’ follow-up she was clinically asymptomatic with no evidence of residual fistula on neuroimaging. Transvenous embolization of AVF is at times necessary when transarterial access is not possible.

Include when citing: Published online April 1, 2019; DOI: thejns.org/doi/abs/10.3171/2019.4.FocusVid.18674.