Medial Tentorial Dural Arteriovenous Fistula Embolization: Single Experience with Embolic Liquid Polymer SQUID and Review of the Literature

World Neurosurg. 2017 Nov;107:1050.e1-1050.e7. doi: 10.1016/j.wneu.2017.08.050. Epub 2017 Aug 18.


Background: Tentorial dural arteriovenous fistulas (DAVFs) are uncommon, complex fistulas located between the leaves of the tentorium cerebelli with a specific anatomic and clinical presentation characterized by high hemorrhagic risk. We present a rare case of a medial tentorial DAVF successfully managed via transarterial embolization using SQUID liquid polymer.

Case description: A 60-year-old woman presented with a history of left progressive hearing loss and tinnitus for >1 year. Cerebral angiography demonstrated the presence of a medial tentorial DAVF with multiple arterial feeders, including the artery of Davidoff and Schechter; reverse venous outflow was observed in the inferior sagittal sinus and in multiple cortical veins. The patient underwent transarterial embolization with SQUID liquid polymer, an embolic agent that provides 2 different viscous formulations to cast the DAVF. The procedure went well without any complication, and the patient regained her preoperative status. In the postprocedural period, the patient experienced complete resolution of tinnitus. At 6 months, she remained asymptomatic, and cerebral angiography confirmed complete, stable occlusion of the fistula and normalization of cerebral deep venous outflow.

Conclusions: Medial tentorial DAVFs are considered the most complex DAVFs because of their location and extensive vascular supply. Our literature review focused on endovascular treatment of tentorial DAVFs to highlight the usefulness of new embolic agents in management of these diseases. To our knowledge, we report the first successful use of SQUID liquid polymer in management of a tentorial DAVF.

Keywords: Dural arteriovenous fistulas; Embolic agents; Embolization; Liquid embolic polymer; Tentorial.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Central Nervous System Vascular Malformations / diagnostic imaging*
  • Central Nervous System Vascular Malformations / therapy*
  • Embolization, Therapeutic / methods*
  • Female
  • Humans
  • Meningeal Arteries / diagnostic imaging*
  • Middle Aged
  • Polyvinyls / administration & dosage*
  • Vertebral Artery / diagnostic imaging*


  • Polyvinyls
  • ethylene-vinyl alcohol copolymer