Spontaneous resolution of a tentorial dural arteriovenous fistula fed by the artery of Wollschlaeger and Wollschlaeger after embolization of the main shunting point

Abstract

Background: Tentorial dural arteriovenous fistula (TDAVF) is a rare intracranial vascular shunt. A TDAVF can be supplied by the Artery of Wollschlaeger and Wollschlaeger (AWW). However, a limited number of cases of TDAVF fed by the AWW have been reported to date. Case Description: A 70-year-old woman complaining of the right motor weakness underwent magnetic resonance imaging. A vascular lesion beneath the cerebellar tentorium was incidentally found with chronic infarction of the left corona radiata. Angiographically, the vascular lesion was a TDAVF supplied by the bilateral posterior meningeal arteries. No other apparent feeders were detected. The TDAVF had a shunting point on the inferior surface of the cerebellar tentorium with venous retrograde flow (Borden type III, Cognard type III). To prevent vascular events, endovascular embolization was performed using n-butyl-2-cyanoacrylate. Following embolization of the shunting point, a residual shunt fed by the AWW was identified. The shunt supplied by the AWW was not observed preoperatively. Follow-up angiography performed 1 week later revealed spontaneous disappearance of the residual shunt. The patient was followed-up in our outpatient clinic, and no recurrence of the TDAVF was confirmed postoperatively. Conclusion: Detection of mild feeding from the AWW to a TDAVF can be elusive preoperatively. Following embolization of the main shunting point, residual shunting from the AWW can resolve spontaneously.