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  • Microsurgical occlusion of arteriovenous fistula of the Bernasconi – Cassinari Artery to vein of Galen guided by intraoperative arteriography

    Final Number:

    Marco Fabián García

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting - Late Breaking Science

    Introduction: The Medial Tentorial Artery (MTA) also known as the Bernasconi - Cassinari Artery, is a branch of the meningohypophyseal trunk of the cavernous segment of the internal carotid artery, is not easily identified in angiograms, it is known mainly as the main vascular aference of the tentorial tumors, and also seen in dural arteriovenous fistulas. We present a case of pontomesencephalic bleeding in a 26-year-old patient with angiographic evidence of an arteriovenous fistula from the MTA to the vein of Galen, endovascular management was performed with difficulties for coiling the MTA, therefore microsurgical management with intraoperative angiography was decided with adequate occlusion of the arteriovenous fistula.

    Methods: we report a case with a arterovenous malformation of the Bernasconi Cassinari Artery, a rare case of dural arterovenous malformation

    Results: the endovascular treatment was difficult because the access to the artery could not be obtained, therefore it required microvascular occlusion with an intraoperative angiographic control with adequate occlusion of the malformation, the patient evolved adequately

    Conclusions: The gold standard of the management of the fistula of the bernasconi cassinari artery are endovascular, is described in the literature as single cases which were not performed in a micro-surgical way, since we do not have endovascular control we perform microvascular occlusion with angiographic intraoperative control with succesful occlusion with the complet treatment for the patient.

    Patient Care: the microsurgical treatment of this uncommon malformation should be taken into account with intraoperative angiographic control in cases of difficulties for endovascular management

    Learning Objectives: microsulgical treatment of a fistula arterovenous malformation of the Bernasconi Cassinari Artery

    References: 1. Byrne JV, Garcia M. Tentorial dural fistulas: endovascular management and description of the medial dural-tento- rial branch of the superior cerebellar artery. AJNR Am J Neuroradiol. 2013 Sep;34(9):1798-804. 2. Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, et al. Cerebral dural arteriovenous fistulas: clin- ical and angiographic correlation with a revised classification of venous drainage. Radiology. 1995 Mar;194:671-80. 3. Daniels DJ, Vellimana AK, Zipfel GJ, Lanzino G. Intracranial hemorrhage from dural arteriovenous fistulas: clinical fea- tures and outcome. Neurosurg Focus. 2013 May;34(5):E15. 4. Davies MA, Ter Brugge K, Willinsky R, Wallace MC. The natural history and management of intracranial dural arteriovenous fistulae. Part 2: aggressive lesions. Interv Neuroradiol. 1997 Dec;3(4):303-11. 5. Dmytriw AA, Schwartz ML, Cusimano MD, Mendes Pereira V, Krings T, Tymianski M, et al. Gamma Knife radiosurgery for the treatment of intracranial dural arteriovenous fistulas. Interv Neuroradiol. 2017 Apr;23:211-20. 6. A.D. Banerjee H. Ezer A. Nanda. The Artery of Bernasconi and Cassinari: A Morphometric Study for Superselective Catheterization. AJNR Am J Neuroradiol 32:1751–55 - Oct 2011

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