Neurosurgical focus: Video最新文献

Scalp arteriovenous fistulas are abnormal connections between scalp arteries and draining veins without an intervening capillary bed. They may present as discolored nodules or pulsatile soft scalp lesions. These lesions are most commonly fed by the superficial temporal and occipital arteries with venous drainage typically occurring through extracranial veins. Intracranial venous drainage is rare. Management options include surgical excision, endovascular embolization, or direct intralesional sclerosing agent injection. Here the authors present a case of a scalp arteriovenous fistula with intracranial drainage treated with microsurgical resection by an expert interdisciplinary team, highlighting the importance of collaborative, tailored treatment strategies for optimal outcomes. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID25109.

Pial arteriovenous fistulas (pAVFs) in pediatric patients are a rare, usually congenital, high-flow vascular anomaly. Because of their rarity, there are no consensus treatment guidelines. Although most pAVFs can be treated endovascularly, surgical treatment has yielded higher obliteration rates. Superficial pAVF varix location and angioarchitecture difficult for endovascular flow occlusion can also make resection more favorable. Here the authors present the case of an incidentally diagnosed left posterior parietal pAVF in a 14-year-old boy, which was treated successfully with a craniotomy and fistula ligation. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID25107.

Atypical arteriovenous fistulas (AVFs) lack the parenchymal nidus observed in arteriovenous malformations (AVMs) and are not dural-based lesions supplied by meningeal arteries, unlike true dural AVFs. Atypical AVFs are parenchymally based with a nondural arterial supply. This video presents a man in his 50s with a remote carotid takedown for flow reduction of a described temporal AVM. Imaging showed a basal temporal AVF supplied by middle cerebral artery branches, coalescence of arterial feeders onto a large venous varix, and no intervening nidus. Dearterialization of the venous varix eliminated the shunting lesion. Atypical AVFs are often misdiagnosed but can be cured with microsurgical interruption. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2587.

Microsurgical treatment of arteriovenous fistulas (AVFs) of the anterior fossa is indicated when endovascular approaches carry excessive risk due to the involvement of the ethmoidal arteries. A 72-year-old male presenting with episodes of blurred vision was found to have an atypical Cognard type IV ethmoidal AVF with combined dural and pial supply from an orbitofrontal branch. He underwent supraorbital craniotomy via eyebrow incision for successful clip ligation of the AVF at the cribriform plate. The supraorbital eyebrow approach offers a minimally invasive corridor, enabling direct visualization and disconnection of anterior fossa AVFs while minimizing brain retraction and cosmetic impact. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2559.

The authors present the case of a type IVc filum terminale arteriovenous fistula in a female patient in her 40s, who presented with lower abdominal pain, back pain, and lower extremity weakness. MRI showed an intradural mass with serpiginous vessels. Spinal angiography revealed a type IVc perimedullary fistula primarily fed by the anterior spinal artery with a giant venous varix. Because of anatomical factors, endovascular embolization was not feasible, and surgical ligation was performed via laminectomy at L1-3. The fistula seen within the filum terminale was successfully clipped, with no further venous outflow on angiography. The patient recovered with complete symptom improvement. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2536.

This video demonstrates the case of a Cognard type V tentorial dural arteriovenous fistula that was successfully salvaged using augmented reality-assisted microsurgery following failed endovascular embolization. The patient had a spastic gait and quadrilateral numbness. MRI showed medullary edema and abnormal vessels near the tentorium. DSA confirmed a shunt fed by the meningohypophyseal trunk draining into perimedullary veins. Initial embolization was unsuccessful. Using CISS MRI and augmented reality projection, the authors identified and ligated the arterialized veins, relieving venous hypertension. Postoperative imaging showed improvement of the brainstem edema. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2541.

Ethmoidal DAVFs represent 10%-15% of all intracranial DAVFs. They are generally associated with a higher bleeding risk due to more malignant drainage characteristics and, regardless of a patient's symptoms, their treatment is highly recommended. Surgical disconnection has long been regarded as the gold-standard treatment for ethmoidal DAVFs, but several reports of successful endovascular treatments have been made. The authors present a case of a 65-year-old patient with an occasional finding of ethmoidal DAVF treated through an endoscope-assisted supraorbital eyebrow approach. In this video, they explain the radiographical, anatomical, and surgical considerations and demonstrate the surgical technique. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2580.

Spinal dural arteriovenous fistulas (dAVFs) at the craniocervical junction are rare vascular lesions that can cause progressive myelopathy and paralysis. This video presents a 40-year-old male with a left C1 spinal dAVF, who experienced unsteadiness, dizziness, leg weakness, and intermittent facial numbness. Given the lesion's symptomatology, the patient underwent a C1 laminectomy and midline suboccipital craniectomy for definitive obliteration. The authors describe key surgical techniques for fistula exposure and obliteration, with intraoperative angiographic confirmation. Long-term follow-up confirmed complete persistent occlusion on angiography and resolution of his symptoms. This case highlights surgical strategies for managing dAVFs at the craniocervical level. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2573.

Arteriovenous fistula of the craniocervical junction is a rare vascular malformation. Although a precise understanding of its angioarchitecture is essential for appropriate and curative treatment, a preoperative diagnosis can be difficult owing to its complexity. Intraoperative findings may provide more clues to the definitive diagnosis. In this video, the authors present an operative technique for exposing a radicular arteriovenous fistula at the craniocervical junction fed by the radicular and spinal pial arteries draining into the common intradural vein. This fistula was definitively diagnosed based on intraoperative findings and treated by disconnecting the common draining vein. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2526.