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DOI: 10.1055/s-2007-970560
Commentary “Resolution of an Anterior-Inferior Cerebellar Artery Feeding Aneurysm with the Treatment of a Transverse-Sigmoid Dural Arteriovenous Fistula”
Publikationsverlauf
Publikationsdatum:
23. März 2007 (online)
In this case report, a feeding-artery aneurysm developed on the anterior inferior cerebellar artery (AICA) after transarterial embolization of a transverse-sigmoid sinus dural arteriovenous fistula (AVF) and skeletonization of the transverse and sigmoid sinuses. Intracranial dural AVFs typically do not derive much blood supply from cerebral or cerebellar arteries, and the development of an aneurysm on such an artery is a rare finding. This association is not rare with spinal dural AVFs; I have seen several and have reported one such case.[1]
Although the focus of this report is this association between the dural AVF and AICA aneurysm, I would comment on the therapeutic management. Complete elimination of the fistula required staged embolizations and staged surgeries, including a transpetrosal approach to resect the sigmoid sinus. The fistula was not cured until a final transvenous embolization obliterated the transverse sinus. It is possible and likely that the fistula could have been obliterated simply with transvenous obliteration of the sinuses, sparing the patient the other interventions. I would have considered this therapy as a first step rather than as a last resort. Transvenous obliteration of transverse-sigmoid sinus dural AVFs is particularly efficacious and can limit the need for surgery when endovascular therapies are incomplete or unsuccessful. If called to operate under these circumstances, I would have occluded the fistula and considered clipping the AICA aneurysm, since the same retrolabyrinthine approach would have provided ample exposure of the aneurysm. Definitive treatment of the aneurysm adds minimal additional risk and eliminates the uncertainty surrounding aneurysm regression.