Early interventions for tentorial dural arteriovenous fistula

Abstract

Dural arteriovenous fistulae (DAVF) constitute 10-15% of all intracranial vascular malformations. As a subtype of DAVF, tentorial DAVF are even rarer, but their aggressive nature warrants early intervention. With regards to symptoms, 70-88% of the cases present with bruits or tinnitus, 60-74% with intracranial haemorrhages, 23-42% with central nerve deficits, 14-17% with cranial nerve deficits, and finally 8-25 % with headaches. Here we report three cases of tentorial DAVF with a primary manifestation of headaches: the first patient is a 44-year-old woman who presented with a severe, persistent sharp occipital headache for 1 day. She deteriorated quickly after admission and required emergency posterior fossa decompression for evacuation of an acute right cerebellar haematoma. Intra-operative and pathological findings suggested a cerebellar arteriovenous malformation. She subsequently underwent transarterial embolisation and surgical excision of the lesion. A review of the histopathological features will be presented. The second case is a 61-year-old male with a 3-4-day history of headache and vomiting prior to presenting to the emergency department with acute delirium secondary to subarachnoid haemorrhage in the posterior fossa. The third case is a 55-year-old woman with moderate, recurrent generalised headaches for 4-5 years. She was managed expediently with transarterial embolisation and had a good outcome. In view of the poor prognosis associated with DAVF rupture, early diagnosis and treatment is warranted to achieve favourable outcomes.