A tentorial dural arteriovenous fistula successfully treated with interruption of leptomeningeal venous drainage using microvascular Doppler sonography - Case report

BACKGROUND Complete interruption of a dural arteriovenous fistula (DAVF) ha s been confirmed intraoperatively by visual inspection and intraoperative a ngiography. To confirm complete interruption of the shunt flow during the s urgical treatment of a tentorial DAVF, we used intraoperative microvascular doppler monitoring. CASE DESCRIPTION A 71-year-old man suffered from severe subarachnoid hemorr hage. Angiography showed a tentorial DAVF with pure leptomeningeal drainage associated with a venous pouch. After the patient's neurologic condition h ad improved, he underwent interruption of the draining vein via a right sub occipital approach. An arterialized drainage vein was easily identified by applying the microvascular doppler probe to the shunting vessels and was co mpletely obliterated by clipping. There were no complications associated wi th use of the microvascular doppler. The postoperative course was uneventfu l and follow-up angiography showed complete obliteration of the DAVF CONCLUSION Intraoperative microvascular doppler monitoring is a useful tech nique not only for evaluating arterialized leptomeningeal drainage veins bu t also for confirming the complete obliteration of these vessels. (C) 2001 by Elsevier Science Inc.