C107 Endovascular management of an intracranial borden type II arteriovenous fistula

<h3>Introduction</h3> Dural arteriovenous fistulas (dAVFs) are vascular anomalies characterized by direct drainage of dural arteries into dural venous sinuses. Borden type II dAVFs are typified by retrograde drainage into subarachnoid cortical veins, which is theorized to predispose to greater morbidity and mortality due to venous hypertension. Endovascular embolization is performed to achieve partial or complete disconnection of the pathological venous drainage. <h3>Case Description</h3> A 76-year-old man with a history of hypertension presented with persistent headache following a mechanical fall two weeks prior. CT imaging of the head revealed right lateral intraventricular hemorrhage with adjacent enlarged serpiginous vessels, which were noted to drain into tortuous superficial leptomeningeal veins and into the deep venous system via the internal cerebral veins. Selective right external carotid artery and vertebral artery catheterization demonstrated a Borden Type II intracranial dAVF, supplied by feeders of the right middle meningeal artery as well as bilateral occipital and vertebral arteries, with drainage into the torcula and cortical veins. The patient underwent multiple rounds of transarterial embolization via the right middle meningeal and occipital arteries using n-butyl cyanoacrylate liquid embolic agent, achieving successful reduction of arteriovenous shunting. <h3>Conclusions</h3> Intracranial type II dAVFs are pathologic communications between the meningeal arteries and the dural venous sinuses associated with cortical venous reflux. They are considered high-grade dAVFs due to their aggressive natural course and elevated risk of hemorrhage and neurologic decline. Endovascular embolization is a cornerstone of treatment, aiming to reduce dAVF flow or to achieve complete shunt obliteration. <h3>Conflict of Interest</h3> No