Deep venous drainage is observed into the Galenic and Straight Sinus of the posterior fossa. Successful trans-arterial embolization with liquid embolic (N-butyl cyanoacrylate, NBCA) of the bilateral external and left vertebral posterior meningeal artery feeders was successful at reducing >90% of these high-pressure indirect shunts (Figure 1D), with small residual shunts from the distal occipital arteries that were subsequently targeted for cure with Gamma Knife Radiosurgery.
Figure 1. [A] Ruptured aneurysm of the Deep Venous Posterior Fossa drainage and AV shunting [B] Posterior Meningeal Artery Fistula [C] Right Middle Meningeal Artery Fistula [D] Post embolization Left Vertebral Angiogram demonstrates resolution of the high flow and pressure AV Shunting following successful embolization with liquid embolic (NBCA).
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Management of tentorial dural arteriovenous malformations: transarterial embolization combined with stereotactic radiation or surgery. Lewis A, Tomsick T, Tew J. Journal of Neurosurgery. Volume 81: Issue 6 (Dec 1994). Issue 6 (Dec 1994). Here is the link https://pubmed.ncbi.nlm.nih.gov/7965115
A 53-year-old man presented with acute onset of severe headache, and possible witnessed seizure. Imaging confirmed intraventricular hemorrhage primarily focused within the fourth ventricle with diffuse subarachnoid hemorrhage within the posterior fossa and along the tentorium (Figure 1A). No severe neurologic deficits were observed initially. His cerebral angiogram revealed a high flow dural arterial-venous fistulous malformation of the tentorium supplied by the bilateral external carotid and left vertebral arteries into a large venous varix within the fourth ventricle at the site of the hemorrhage (Figure 1B, C).
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