Case Courtesy Dr. Peter Kim Nelson

Typical Tentorium Cerebelli Fistula — a dural fistula on the surface of tentorium cerebelli draining primarily into cerebellar veins rather than venous sinus. By definition a high grade Borden/Cognard fistula

Typical supply from MMA and Occipital arteries

Vert injection with another typical feeder — artery of tentorium cerebelli — part of posterior meningeal artery group.  There is extensive venous congestion of the cerebellum

Distal MMA petrosquamosal branch catheterization — the safest branch from which to glue

Sequential images of nBCA injection, with excellent penetration of primary cortical vein

Post-embo ECA and CCA images

Control injection must be carried out from every source of supply. Vert injection shows no more fistula.  The abnormal cerebellar veins are not being used by the brain.  They will never be completely normal — like in many fistulas what we need to achieve is closure of fistula to eliminate additional venous congestion from fistula inflow.   The brain will use what veins it has, which is usually enough

For more info on dural venous channels, click on link here.