How I do it: surgical ligation of posteromedial tentorial dural arteriovenous fistulas

Tentorial dural arteriovenous fistulas (dAVFs) are categorized based on venous drainage and location. Although their angioarchitecture may initially appear intimidating, once “decodified,” treatment is straightforward. Posteromedial tentorial dAVFs have an arterialized draining vein that emanates from the inferior tentorium along the posterior third of the straight sinus, just slightly off the midline.

With the aid of anatomical dissections, intraoperative photos, and operative videos, we outline the key steps for surgical treatment of posteromedial tentorial dAVFs.

Posteromedial tentorial dAVFs constitute a precise and well-defined subtype of tentorial dAVF for which surgical ligation has an important role.