• Andrea Gioppo, Giuseppe Faragò, Valentina Caldiera, Luigi Caputi, Alberto Cusin, and Elisa Ciceri.
• Department of Neuroradiology, Interventional Unit, IRCCS Foundation Neurological Institute "C. Besta", Milano, Italy; Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milano, Italy.
• World Neurosurg. 2017 Nov 1; 107: 1050.e1-1050.e7.

BackgroundTentorial dural arteriovenous fistulas (DAVFs) are uncommon, complex fistulas located between the leaves of the tentorium cerebelli with a specific anatomic and clinical presentation characterized by high hemorrhagic risk. We present a rare case of a medial tentorial DAVF successfully managed via transarterial embolization using SQUID liquid polymer.Case DescriptionA 60-year-old woman presented with a history of left progressive hearing loss and tinnitus for >1 year. Cerebral angiography demonstrated the presence of a medial tentorial DAVF with multiple arterial feeders, including the artery of Davidoff and Schechter; reverse venous outflow was observed in the inferior sagittal sinus and in multiple cortical veins. The patient underwent transarterial embolization with SQUID liquid polymer, an embolic agent that provides 2 different viscous formulations to cast the DAVF. The procedure went well without any complication, and the patient regained her preoperative status. In the postprocedural period, the patient experienced complete resolution of tinnitus. At 6 months, she remained asymptomatic, and cerebral angiography confirmed complete, stable occlusion of the fistula and normalization of cerebral deep venous outflow.ConclusionsMedial tentorial DAVFs are considered the most complex DAVFs because of their location and extensive vascular supply. Our literature review focused on endovascular treatment of tentorial DAVFs to highlight the usefulness of new embolic agents in management of these diseases. To our knowledge, we report the first successful use of SQUID liquid polymer in management of a tentorial DAVF.Copyright © 2017 Elsevier Inc. All rights reserved.

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