• Ivo Peto, Hussam Abou-Al-Shaar, and Amir R Dehdashti.
• Department of Neurosurgery, North Shore University Hospital, Long Island, New York, USA. Electronic address: Ivo.peto@icloud.com.
• World Neurosurg. 2019 Jul 1; 127: 485.

AbstractPosterior fossa dural arteriovenous fistulas are rare vascular malformations. If associated with cortical venous reflux, they present a significant risk of hemorrhage. We present a 54-year-old male who presented with progressive hearing loss without other neurologic symptoms. Further workup revealed tentorial incisura dural arteriovenous fistula with cortical venous reflux and aneurysmal dilation of venous drainage (type IV Cognard), fed from the right internal carotid artery and external carotid artery. After multidisciplinary discussion, we decided on surgical disconnection of the fistula as we felt this approach would have the highest chance of immediate and durable cure. We performed a right retrosigmoid craniotomy with (Video 1) disconnection of the arterialized veins and thus achieved completed obliteration. Follow-up angiography 8 months later showed no evidence of residual/recurrent fistula. The patient's hearing improved. There were no adverse effects during the perioperative period.Copyright © 2019 Elsevier Inc. All rights reserved.

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