{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:07:07Z","timestamp":1779361627379,"version":"3.51.4"},"reference-count":86,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"20","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,5,18]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Dural arteriovenous fistulas (dAVFs) of the lesser sphenoid wing (LSW) are exceedingly rare, and their angioarchitectural features, natural history, and optimal management remain poorly defined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The complex anatomy of the sphenoparietal sinus and its controversial relationship with LSW-dAVFs necessitate precise, LSW-specific terminology to guide management. Starting from these premises, 3 patients with LSW-dAVF (Borden type III) underwent microsurgical treatment. Across the authors\u2019 series and 19 papers from the literature, LSW-dAVF showed arterial supply from the middle meningeal artery (89.3%) and the ophthalmic artery (OphtA) (60.7%). Venous drainage typically occurred through a bridging vein originating from the LSW, immediately lateral to the superior orbital fissure, with secondary recruitment of the superficial and deep sylvian veins. An endovascular approach was selected as the first-line treatment in 64% of 28 reported cases, and complete angiographic occlusion was achieved in about one-third of these procedures (endovascular failure rate approximately 67%). In contrast, microsurgical clip ligation resulted in complete obliteration in all surgically treated patients, with no reported mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>The complex angioarchitecture of LSW-dAVFs favors microsurgical management, as it provides direct access, definitive cure, and low morbidity. Endovascular therapy is limited by the anatomical features of these fistulas, which predispose to incomplete occlusion with the risks associated with navigation of the OphtA.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26129\">https:\/\/thejns.org\/doi\/10.3171\/CASE26129<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26129","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T12:56:50Z","timestamp":1779109010000},"source":"Crossref","is-referenced-by-count":0,"title":["Rethinking the sphenoparietal sinus: implications for lesser sphenoid wing dural arteriovenous fistulas. Illustrative cases"],"prefix":"10.3171","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5155-6736","authenticated-orcid":true,"given":"Simona","family":"Serioli","sequence":"first","affiliation":[{"name":"Department of Neuroscience and Surgery of the Nervous System, Ospedale Papa Giovanni XXIII, Bergamo"},{"name":"Technology for Health, PhD Program, University of Brescia"},{"name":"Cerebrovascular Disease Group, Ospedale Papa Giovanni XXIII, Bergamo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Seguini","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Surgery of the Nervous System, Ospedale Papa Giovanni XXIII, Bergamo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0798-6197","authenticated-orcid":true,"given":"Luca","family":"Quilici","sequence":"additional","affiliation":[{"name":"Cerebrovascular Disease Group, Ospedale Papa Giovanni XXIII, Bergamo"},{"name":"Department of Neuroradiology, Papa Giovanni XXIII Hospital, Bergamo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Lunghi","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Casa di Cura San Francesco, Bergamo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Gritti","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care Medicine, Papa Giovanni XXIII Hospital, Bergamo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4590-3575","authenticated-orcid":true,"given":"Alfonso","family":"Ciccone","sequence":"additional","affiliation":[{"name":"Cerebrovascular Disease Group, Ospedale Papa Giovanni XXIII, Bergamo"},{"name":"Department of Neurology, Papa Giovanni XXIII Hospital, Bergamo"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo Giorgio","family":"Giussani","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Surgery of the Nervous System, San Gerardo Hospital, Monza, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi A.","family":"Lanterna","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Surgery of the Nervous System, Ospedale Papa Giovanni XXIII, Bergamo"},{"name":"Cerebrovascular Disease Group, Ospedale Papa Giovanni XXIII, Bergamo"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Radiology","first-page":"671","article-title":"Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage","volume":"194","author":"Cognard","year":"1995","unstructured":"Cognard CGobin YPPierot LCerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. 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