Cognard Grade IV Tentorial Dural Arteriovenous Fistula Presenting as Trigeminal Neuralgia: Endovascular Management

World Neurosurg. 2020 Dec;144:184. doi: 10.1016/j.wneu.2020.08.119. Epub 2020 Aug 20.


Tentorial dural arteriovenous fistulas have an increased risk of rupture and hemorrhage, and therefore require urgent treatment to occlude the fistula and proximal venous drainage. This is usually accomplished via endovascular treatment. We present a case of a Cognard grade IV dural arteriovenous fistula that presented as trigeminal neuralgia. This video showcases the angiographic vascular composition of the lesion with main feeders coming from the middle meningeal artery and the tentorial artery of Bernasconi and Cassinari. Details, benefits, and risks of the procedure were thoroughly discussed with the patient and consent was obtained prior to the procedure. We performed endovascular Onyx embolization through a distal branch of the right middle meningeal artery. We were able to successfully occlude the lesion using Onyx embolization and the patient had significant improvement of her pretreatment trigeminal neuralgia.

Keywords: Tentorial dural arteriovenous fistula; Trigeminal neuralgia.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Central Nervous System Vascular Malformations / complications
  • Central Nervous System Vascular Malformations / diagnostic imaging
  • Central Nervous System Vascular Malformations / surgery*
  • Cerebral Angiography
  • Dimethyl Sulfoxide
  • Embolization, Therapeutic / methods*
  • Humans
  • Meningeal Arteries / surgery
  • Polyvinyls
  • Treatment Outcome
  • Trigeminal Neuralgia / diagnostic imaging
  • Trigeminal Neuralgia / etiology
  • Trigeminal Neuralgia / surgery*


  • Onyx copolymer
  • Polyvinyls
  • Dimethyl Sulfoxide