Manejo microquirúrgico de fístula arteriovenosa dural tentorial entre arteria de Bernasconi-Cassinari y vena de Galeno guiada por angiografía intraoperatoria: reporte de caso y revisión de la literatura

Abstract

Dural arteriovenous fistulas (DAVFs) are anomalous vascular connections between dural arteries and venous sinuses or cerebral cortical veins. These shunts can present with intracranial ischemia or hemorrhage that result from increased venous drainage or cortical venous hypertension, implicit in its pathophysiology. The "gold standard" technique for diagnosis is cerebral digital subtraction angiography, however, there are different imaging techniques that provide important information for its characterization and classification. The Borden-Shucart system and the Cognard scale are the best known classification systems. Therapeutic strategies for its management include endovascular and/or surgical methods. In general terms, in recent years endovascular management has replaced surgical management since it is associated with a lower rate of morbidity and mortality (mortality < 9%) and shorter hospital stay. Tentorial dural arteriovenous fistulas (TDAVFs) account for4 to 8% of all DAVFs and they are the subtype with the highest risk of bleeding, which occurs in 38 to 74% of patients. In the present article we describe the case of an adult patient with a TDAVF between the Bernasconi-Cassinari artery and the Galen vein associated with mesencephalic hemorrhage. The patient underwent microsurgical management guided by intraoperative angiography, obtaining complete occlusion of the fistulous defect with no complications and with an adequate postoperative evolution.