PMC3115227_01
Brain computed tomography scan showing right thalamic hemorrhage with extension into the lateral ventricle, producing acute hydrocephalus, midline shift toward the left and transtentorial herniation
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F1
Computed tomography scan of the head revealed a hematoma in the right lateral thalamus, extending into the lateral ventricles, producing acute hydrocephalus and a midline shift toward the left [Figure 1].
Selective angiogram of the right internal carotid artery (a and b) revealing an arteriovenous fistula, Borden type III, involving the right tentorial leaf fed by the meningohypophyseal trunk. Venous drainage proceeds through the lateral mesencephalic vein to the basal vein of Rosenthal and the straight sinus. The basal vein of Rosenthal has a saccular dilatation of 2 cm on its superior surface representing a false aneurysm most probably responsible for the repetitive hemorrhages. Selective angiogram of the right external carotid artery (c) demonstrating minimal contribution by the petrous branch of the middle meningeal artery
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F2
Cerebral angiography revealed a right-sided tentorial DAVF fed primarily by the tentorial artery of Bernasconi and Cassinari and, to a lesser extent, by the petrous branch of the middle meningeal artery [Figure 2]. Venous drainage was via the lateral mesencephalic vein, through an aneurysmal dilated basal vein of Rosenthal, to the straight sinus [Figure 2].
Selective right vertebral arteriogram. Anteroposterior (a) and lateral (b) view demonstrating suspicion of a tentorial branch arising from the rostral trunk of the SCA (arrow)
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F3
In addition, the presence of a small dural feeder originating from the SCA was suspected [Figure 3].
Intraoperative photograph showing the tentorial branch (asterix) arising from the SCA (black arrow) in the ambient cistern after division and elevation of the tentorium (white arrow)
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F4
Intraoperatively, after division of the tentorium, a tentorial branch originating from the SCA was identified [Figure 4].