Neurosurgical focus: Video最新文献

This is a video presentation of a complex tentorial arteriovenous fistula that required multimodal treatment with preoperative embolization followed by craniotomy for clip ligation with several teaching points. A Cognard type IV fistula has multiple arterial feeders and direct cortical venous drainage with venous ectasia. A multimodal approach was required, consisting of endovascular embolization of occipital feeders followed by tailored craniotomy for clip ligation of the venous outflow of the fistula. The video discusses important nuances for the successful treatment of complex arteriovenous fistulas while minimizing morbidity. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2597.

Tentorial dural arteriovenous fistulas (TDAVFs) are rare but high-risk lesions due to frequent deep venous drainage. A 77-year-old woman presented with a ruptured, high-grade (Borden III, Cognard IV, Zipfel 3S) TDAVF at the pontomesencephalic junction. Angiography revealed feeders from the left middle meningeal artery, occipital artery, and meningohypophyseal trunk with tortuous venous drainage into a partially thrombosed varix. Initial transarterial N-butyl cyanoacrylate (N-BCA) embolization was incomplete. Definitive cure was achieved with transvenous coiling. Postoperatively, the patient was neurologically stable, and follow-up angiography revealed no further arteriovenous shunting, demonstrating how staged embolization can lead to curing TDAVFs with complex angioarchitecture. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2593.

A 63-year-old woman with a history of stroke underwent further workup. MRI revealed a region of asymmetrical ASL hyperintensity near the right hypoglossal canal. Angiogram revealed a left foramen magnum region dural arteriovenous fistula supplied by a left V4 vertebral artery branch, with early draining veins into the skull base and left sigmoid sinus. Attempts were made to catheterize the fistula, but it was not amenable to endovascular intervention. A far-lateral craniotomy with C1 hemilaminectomy was performed, with obliteration confirmed on postoperative DSA. At 2-year follow-up, the patient remained at her neurological baseline with no evidence of recurrence. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2579.

In this video, the authors present the microsurgical treatment of a superior petrosal dural arteriovenous fistula (dAVF) associated with a symptomatic hemorrhagic brainstem cavernous malformation in a 38-year-old male. The patient underwent a retrosigmoid craniotomy for cavernoma evacuation and fistula disconnection. Intraoperative indocyanine green angiography revealed cortical venous reflux not evident on catheter angiography, prompting reclassification to a higher-grade fistula. Postoperatively, the patient returned to neurological baseline, and follow-up imaging confirmed complete fistula obliteration, cavernoma resection, and new appearance of a developmental venous anomaly (DVA). This case highlights the dynamic nature of dAVF venous drainage and illustrates the rare co-occurrence of dAVF, DVA, and brainstem cavernoma. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2553.

Straight sinus dural arteriovenous fistulas (dAVFs), classified as tentorial type 2, can be approached with a torcular craniotomy and supracerebellar infratentorial approach, with gravity retraction from a sitting position optimizing the view. This video presents the case of a man in his early 60s with a thunderclap headache. Imaging showed a subarachnoid hemorrhage, and angiography confirmed a straight sinus dAVF. Endovascular embolization reduced flow, but further obliteration with surgical ligation was required. Intraoperative identification of the arterialized veins led to the fistula, and 2 efferent veins were clipped and divided. The patient tolerated the procedure well without new deficits, and angiography confirmed dAVF occlusion. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2586.

Dural arteriovenous fistulas (DAVFs) are rare with a low incidence. Tentorial DAVFs account for 10%-15% of all intracranial DAVFs and are associated with an aggressive clinical course. Petrosal DAVFs are a subtype of tentorial DAVFs and account for approximately 26% of tentorial DAVFs. They are supplied by the marginal tentorial artery or external carotid artery branches and drain into the petrosal vein and/or the superior petrosal sinus. Petrosal DAVFs may be challenging to treat endovascularly, while surgical management is often relatively safe and effective. Here the authors present two cases of surgically managed petrosal DAVFs. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2598.

The authors discuss the first reported case of bilateral spontaneous indirect carotid-cavernous fistula (CCF) treated by a hybrid open-endovascular approach bilaterally. A 74-year-old man presented to the emergency department following 1 month of progressive right-eye proptosis with increased intraocular pressure. Cerebral angiography confirmed bilateral indirect type D CCF. Attempts to access the cavernous sinus through the petrosal sinuses were unsuccessful. The right-sided CCF was successfully treated via surgical exposure of the superior ophthalmic vein for endovascular deployment of coils and liquid embolic agent. The left-sided CCF was similarly treated after gaining cavernous sinus access via craniotomy to catheterize the left sylvian vein. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID25103.

Endovascular transarterial or retrograde transvenous occlusion is the preferred modality for treatment of dural arteriovenous fistulas at most intracranial locations. However, transvenous navigation to the segment of interest might not be possible due to occlusion or stenosis of an extracranial or intracranial major venous channel. Direct transcranial access to a major venous sinus proximal to the occlusion is a useful strategy in such situations. This video demonstrates successful endovascular coil embolization of an external carotid artery-internal jugular vein fistula below the jugular foramen through direct transcranial access to the transverse-sigmoid sinus in a patient with bilateral internal jugular vein occlusion. The video can be found here: https://stream.cadmore.media/r10.3171/2025.7.FOCVID2537.

In traditional minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), the primary fusion mass comes from the interbody space. In this case report of a 58-year-old female undergoing a MIS-TLIF for grade 2 spondylolisthesis, the authors demonstrate a novel MIS posterolateral fusion technique using robot-guided facet decortication. This method enhances the fusion surface area in patients with osteopenia or spondylolisthesis and advances robotic spine fusion strategies. The video can be found here: https://stream.cadmore.media/r10.3171/2025.4.FOCVID2520.

Robotic assistance in spine surgery has provided new advancements for less invasive surgical options for patients who may otherwise not have qualified for these procedures in the past. The authors report the case of a 62-year-old woman with stage 4 metastatic breast cancer and osteoporosis who presented with debilitating bilateral lower extremity radiculopathy. MRI showed grade 2 spondylolisthesis at L5-S1 causing severe biforaminal stenosis. The video demonstrates use of the robot to ensure proper placement of the hardware as well as to preplan the L4 to S2-alar-iliac construct to allow for the least invasive surgery possible. The video can be found here: https://stream.cadmore.media/r10.3171/2025.1.FOCVID24153.