Nuances of transarterial and transvenous embolization of a large tentorial arteriovenous fistula

Lorenzo Rinaldo, Waleed Brinjikji, Leonardo Rangel-Castilla

Research output: Contribution to journalArticle


An 80-year-old female presented with a long history of severe pulsatile tinnitus, vertigo, and decreased hearing. She was found to have a large right-sided tentorial arteriovenous fistula (AVF) with enlarged deep draining veins, including the vein of Rosenthal. The patient underwent Onyx embolization of the fistula via a combined transarterial and transvenous approach resulting in complete obliteration of the fistula. Her symptoms improved immediately after the procedure and at 6-months' follow-up she was clinically asymptomatic with no evidence of residual fistula on neuroimaging. Transvenous embolization of AVF is at times necessary when transarterial access is not possible.

Original languageEnglish (US)
Article numberV12
JournalNeurosurgical focus
StatePublished - Jan 1 2019



  • Arteriovenous fistula
  • Endovascular procedures
  • Onyx
  • Tentorium cerebelli
  • Video

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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