• Liyong Sun, Jian Ren, Long Wang, Jingwei Li, Chuan He, Ming Ye, Guilin Li, and Hongqi Zhang.
• Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
• World Neurosurg. 2020 Sep 1; 141: e836-e843.

BackgroundSuperior petrosal sinus (SPS) dural arteriovenous fistulas (DAVFs) are a common subtype of tentorial DAVFs that often require microsurgical treatment. We have noted a rare condition involving the presence of a coexisting normal superior petrosal vein (SPV) during surgery for SPS DAVFs; this condition has not been reported in the literature. Identification and preservation of coexisting normal veins are crucial to prevent venous complications.MethodsWe reviewed data of 12 patients with SPS DAVFs who underwent microsurgical treatment. Intraoperative indocyanine green video angiography was used to confirm the location of the fistula and identify the normal SPV. Postoperative radiologic examination was performed, and the clinical outcome was evaluated with the modified Rankin Scale.ResultsA coexisting normal functional SPV was found in 6 cases. Analysis of the tributaries of the SPV showed the vein of the cerebellopontine fissure was the most frequent arterialized drainage vein (66.7%), while the pontotrigeminal vein was the most frequent normal drainage vein (45.5%). The DAVFs were easily identified and disrupted using intraoperative indocyanine green video angiography. The normal SPV was also successfully preserved. All 6 patients experienced good clinical and radiologic outcomes.ConclusionsAn SPS DAVF can coexist with a normal functional SPV, which should be preserved. Use of indocyanine green video angiography is an efficient way to identify the normal SPV.Copyright © 2020. Published by Elsevier Inc.

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