Abstract
Dural arteriovenous fistulas (DAVFs) are rare intracranial vascular lesions most commonly found in the transverse sinus.1 DAVFs of the sphenoparietal sinus are exceedingly rare, usually treated by endovascular embolization treatment.2-5 In this video, we present a man in his 50s with a ruptured sphenoparietal DAVF who was successfully treated with clip occlusion. The patient presented with sudden-onset hemiparesis, aphasia, and altered mental status. A large intracerebral hematoma was found in his left basal ganglia causing herniation. Computed tomography revealed dilatation of the veins draining the sphenoparietal sinus, including reflux into the left basal vein of Rosenthal. Consent was obtained from the family, and a pterional craniotomy was performed. The dura was opened and devascularized, and the meningo-orbital band was cauterized. The cisterns were opened, and the fistula was identified in the dura of the sphenoid wing near the meningo-orbital band. It drained posteriorly through a tortuous vein toward the basal vein of Rosenthal. A fenestrated clip and a second fenestrated clip placed in an understacked position were used to occlude the fistula's outflow. Indocyanine green videoangiography confirmed obliteration of the fistula, and the draining vein was cauterized. The hematoma was evacuated. The patient tolerated the procedure well and began to recover from his hemiparesis and aphasia. He was discharged to rehabilitation on postoperative day 10. Treatment of sphenoparietal DAVFs can be simple if the fistula pattern can be recognized. Clips should be placed close to the dura to prevent the formation of a venous pouch and to reduce risk of rupture.