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Objectives  To demonstrate the surgical clipping of a lateral petrosal tentorial dural arteriovenous fistula (DAVF), located in the cerebellopontine angle (CPA), through a retrosigmoid approach. Method  A previously healthy 49-year-old man presented a sudden episode of headache, photophobia, and dizziness. Due to the persistence of his symptoms despite proper analgesic treatment, he sought medical attention. The initial computed tomography (CT) scan showed a hyperdense lesion in the left CPA. Magnetic resonance imaging (MRI) demonstrated the vascular nature of the lesion, corresponding to an engorged superior petrosal vein (SPV) and Rosenthal's vein. The preoperative angiography showed a lateral tentorial DAVF (Lawton's type 5), fed by multiple transpetrous branches coming off the external carotid artery, and draining into the SPV. A standard retrosigmoid approach was planned for clipping and exclusion of the DAVF. Results  Through a left retrosigmoid craniotomy the DAVF was approached, along with the different neurovascular structures of the CPA. The DAVF originated at the tentorial petrosal junction. The fistulous vein was closely attached to the trigeminal nerve and the anterior inferior cerebellar artery (AICA). The fistulous vein was dissected and clipped close to its base at the lateral tentorium, achieving complete occlusion of the DAVF. The patient fully recovered after surgery with neither relapse of his symptoms nor postoperative complications. Conclusion  The retrosigmoid craniotomy is the best surgical approach for lateral tentorial DAVFs, as it provides a direct way to the fistula origin and permits a successful clipping of the draining vein. The link to the video can be found at: https://youtu.be/Fj3uqrTPX5c. [ABSTRACT FROM AUTHOR]

Tentorial dural arteriovenous fistulas (DAVFs) are a dangerous subtype of fistula. Lawton et al classified this type of fistula into 6 categories based on specific operative strategies. Clinical manifestations of 6 types of tentorial DAVFs vary to some extent. Cognard type V DAVFs in the tentorial region are usually petrosal/superior petrosal sinus DAVFs. DAVFs with perimedullary venous drainage around the torcular herophili are rare. The veins of the posterior fossa are intricate and variable. There are anatomic communications between the perimedullary vein and cerebellar vein or veins of the brainstem. Almost all of the Cognard type V DAVFs are found in the posterior fossa. Here, we present a Cognard type V DAVF with a fistula located around the torcular herophili. [ABSTRACT FROM AUTHOR]