{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T18:04:00Z","timestamp":1786125840039,"version":"build-2736575974"},"reference-count":6,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2021,8,23]],"date-time":"2021-08-23T00:00:00Z","timestamp":1629676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Operative Surg.","ONSURG"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Dural arteriovenous fistulas (dAVFs) consist of abnormal anastomoses between 1 or multiple meningeal arteries to meningeal veins, venous sinuses, or subarachnoid veins.\n                    <jats:sup>1<\/jats:sup>\n                    dAVFs account for 10% to 15% of all intracranial arteriovenous lesions.\n                    <jats:sup>2<\/jats:sup>\n                    dAVFs can be challenging to treat with various approaches that include microsurgical ligation, endovascular embolization (transarterial or transvenous), and stereotactic radiosurgery. All these treatments share the common goal of disconnecting the draining vein from the fistulous point. We present a case of a 43-yr-old male who presented with progressive headaches and was found to have an incidental Zipfel type 3A\n                    <jats:sup>3<\/jats:sup>\n                    right petrotentorial dAVF on catheter angiography. The patient underwent a right retrosigmoid craniotomy and clipping of 2 separate venous outflows. The case illustrates the principle that multiple venous outflows can exist in dAVF and a thorough analysis of the venous phase of the angiogram as well as corresponding inspection of the fistula at the time of surgical exploration is a necessity to avoid partial obliteration. The patient remained neurologically intact postoperatively and had complete resolution of his fistula on postoperative angiography. We review the neuroimaging, operative video, and technical nuances and provide a short literature review on the topic.\n                    <jats:sup>4<\/jats:sup>\n                    The patient gave informed consent for the procedure and verbal consent for this publication. The patient consented to the publication of their image.\n                  <\/jats:p>","DOI":"10.1093\/ons\/opab290","type":"journal-article","created":{"date-parts":[[2021,8,23]],"date-time":"2021-08-23T05:51:50Z","timestamp":1629697910000},"page":"E450-E451","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Microsurgical Treatment of a Petrotentorial Dural Arteriovenous Fistula: The Vein, the Whole Vein, and Nothing but the Vein: 2-Dimensional Operative Video"],"prefix":"10.1227","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4099-089X","authenticated-orcid":false,"given":"Nickalus R","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Miami, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9583-6123","authenticated-orcid":false,"given":"Turki","family":"Elarjani","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S Shelby","family":"Burks","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques J","family":"Morcos","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Miami, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,11]]},"reference":[{"issue":"2","key":"bib1-20250821","doi-asserted-by":"crossref","first-page":"166","DOI":"10.3171\/jns.1995.82.2.0166","article-title":"A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment","volume":"82","author":"Borden","year":"1995","journal-title":"J Neurosurg"},{"issue":"3","key":"bib2-20250821","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1148\/radiology.194.3.7862961","article-title":"Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage","volume":"194","author":"Cognard","year":"1995","journal-title":"Radiology"},{"issue":"5","key":"bib3-20250821","doi-asserted-by":"crossref","first-page":"E14","DOI":"10.3171\/2009.2.FOCUS0928","article-title":"Cranial dural arteriovenous fistulas: modification of angiographic classification scales based on new natural history data","volume":"26","author":"Zipfel","year":"2009","journal-title":"Neurosurg Focus"},{"issue":"5","key":"bib4-20250821","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1161\/STROKEAHA.116.012784","article-title":"Intracranial dural arteriovenous fistulae","volume":"48","author":"Reynolds","year":"2017","journal-title":"Stroke"},{"key":"bib1a-20250821","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.wneu.2019.04.227","article-title":"Treatment of ethmoidal dural arteriovenous fistulas: a meta-analysis comparing endovascular versus surgical treatment","volume":"128","author":"Giannopoulos","year":"2019","journal-title":"World Neurosurg"},{"issue":"4","key":"bib2a-20250821","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.3171\/2016.4.JNS153017","article-title":"Microsurgery for cerebral arteriovenous malformations: subgroup outcomes in a consecutive series of 288 cases","volume":"126","author":"Schramm","year":"2017","journal-title":"J Neurosurg"}],"container-title":["Operative Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ons\/article-pdf\/21\/5\/E450\/40515130\/opab290.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab290","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:02:44Z","timestamp":1786122164000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1093\/ons\/opab290"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,23]]},"references-count":6,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1093\/ons\/opab290","relation":{},"ISSN":["2332-4252","2332-4260"],"issn-type":[{"value":"2332-4252","type":"print"},{"value":"2332-4260","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,23]]},"assertion":[{"value":"2021-05-06","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-04","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}