A 24 years old patient suffered an intracerebral hemorrhage from a dural AV fistula treated by a doctor from a community hospital. At that time, he was diagnosed as having a small fistula at the cranial base right at the foramen magnum. This fistula was fed off tiny vessels from the vertebral artery and was not amenable for embolization. The surgical procedure was designed to remove the bone covering the foramen magnum and identify the arterialized vein the subarachnoid space. This was done and it was sacrificed right at the dural entry. Additional parts of the malformation were coagulated on the side of the brain stem.
Hunt Batjer, MD, FACS
Michael J. Marchese Professor of Neurological Surgery and Chair, Northwestern University Feinberg School of Medicine