Background: The tentorial branch of the superior cerebellar artery (SCA) is not well known and is underreported in the literature. In the present study, the authors report and describe a dural branch arising from the SCA that was encountered during the surgical treatment of a tentorial dural arteriovenous fistula (DAVF). The clinical relevance of this branch is discussed.
Case description: A 53-year-old patient suffered a third recurrent right thalamic hemorrhage within 2 weeks rendering him comatose. Computed tomography scan revealed a right thalamic hematoma extending into the ventricles, producing acute hydrocephalus and midline shift. Cerebral angiography revealed a right-sided tentorial Borden type III DAVF fed primarily by the tentorial artery of Bernasconi and Cassinari and, to a lesser extent, the petrous branch of the middle meningeal artery. A small dural feeder originating from the SCA was suspected. Venous drainage was via the lateral mesencephalic vein, through an aneurysmal dilated basal vein of Rosenthal, to the straight sinus. The DAVF was approached surgically via a right subtemporal approach. Intraoperatively, after division of the tentorium, a tentorial branch originating from the SCA was identified. This artery was sectioned while preserving the SCA. The draining vein was ligated adjacent to the sinus. Postoperatively, the patient's neurological status improved and postoperative angiography demonstrated complete obliteration of the tentorial DAVF.
Conclusion: Knowledge of the tentorial branch of the SCA is important as it may potentially be sectioned during division of the tentorium or avulsed from its origin in the SCA during surgical manipulation in the ambient cistern.
Keywords: Dural arteriovenous fistula; dural artery; intracranial hemorrhage; malformation; superior cerebellar artery; tentorial artery.