Journal Pre-proof Ruptured tentorial AV fistula: endoscopic-assisted microsurgical disconnection using ICG-VA guidance Raffaella Messina, MD, Maria Teresa Bozzi, MD, Luigi Chiumarulo, MD, Leonello Tacconi, MD, Francesco Signorelli, MD, MSc PII:
S1878-8750(19)32860-8
DOI:
https://doi.org/10.1016/j.wneu.2019.11.024
Reference:
WNEU 13693
To appear in:
World Neurosurgery
Received Date: 3 August 2019 Revised Date:
3 November 2019
Accepted Date: 4 November 2019
Please cite this article as: Messina R, Bozzi MT, Chiumarulo L, Tacconi L, Signorelli F, Ruptured tentorial AV fistula: endoscopic-assisted microsurgical disconnection using ICG-VA guidance, World Neurosurgery (2019), doi: https://doi.org/10.1016/j.wneu.2019.11.024. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 Elsevier Inc. All rights reserved.
Ruptured tentorial AV fistula: endoscopic-assisted microsurgical disconnection using ICG-VA guidance Raffaella Messina, MD*, Maria Teresa Bozzi, MD*, Luigi Chiumarulo, MD§, Leonello Tacconi, MD#, and Francesco Signorelli, MD, MSc* *
Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University “Aldo Moro” of Bari, Italy § Division of Neuroradiology, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University “Aldo Moro” of Bari, Italy # Division of Neurosurgery, University Hospital of Trieste, Trieste, Italy The authors have no conflicts of interest or personal financial or institutional interest in any of the drugs, materials, or devices described in this article. No funding has been received for the conduct of this study and/or preparation of this manuscript. Corresponding Author: Francesco Signorelli, MD, MSc. Division of Neurosurgery, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University “Aldo Moro” of Bari, Piazza Giulio Cesare,11 70124 Bari, Italy. Email:
[email protected] Keywords: dural arteriovenous fistula; tentorium; indocyanine green; videoangiography; flow dynamics.
Tentorial dural arteriovenous fistulas (DAVFs) are rare causes of intracranial hemorrhage and nervous tissue venous congestion. Due to their extensive arterial supply and difficult transvenous endovascular navigation, they are frequently managed microsurgically. Precise identification of the venous drainage, its retractorless exposition and real-time verification of arteriovenous disconnection are the mainstays of surgery. We describe the case of 61-year-old man presenting with a cerebellar hematoma causing obstructive hydrocephalus, resolved by emergent endoscopic 3rd ventriculocisternostomy, with no need of external ventricular drain.1 Brain angiograms showed a straight sinus DAVF. Fistulous point could not be reached endovascularly, due to the small caliber and tortuosity of the arterial feeders and difficult transvenous navigation, then the endovascular treatment was limited to closure of both occipital arteries. At surgery, indocyanine green video-angiography (ICG-VA) with semiquantitative assessment of flow dynamics identified the draining vein originating from the dura of the left wall of the straight sinus. After the draining vein was clipped at its origin from the straight sinus and the endoscopic view confirmed that the clip's tips straddled the vein, control ICG-VA showed no more early injection of the draining vein and restoration of the normal venous drainage. Postoperative angiograms confirmed the elimination of the fistula. The patient was discharged to a rehabilitation facility five days postoperatively and regained functional independence, with a modified Ranking scale score of zero by the third month after surgery. Relevant teaching points are exposed at the end of the case narration. REFERENCES 1. Chrastina J, Novák Z2, Zeman T et al. The Results of Neuroendoscopic Surgery in Patients with Posttraumatic and Posthemorrhagic Hydrocephalus. World Neurosurg. 2018;113:e113-e121. DOI:10.1016/j.wneu.2018.01.186