Tentorial DAVMs are aggressive lesions that require prompt total angiographic obliteration. Disconnection of the venous drainage from the fistula may be accomplished with transarterial embolization to the venous side, transvenous embolization, or surgical disconnection of the fistula. We think that extensive nidal resections carry more risk and are unnecessary. We do not think there is a role for stereotactic radiosurgery in the treatment of these lesions.

Effects of electric spinal cord stimulation (SCS) on cerebral blood flow (CBF) were investigated in anesthetized adult cats. SCS was performed under various stimulus conditions for 1 h via a wire electrode inserted into the dorsal epidural space at various levels in the spinal cord. CBF was measured in the subcortex of the parietal lobe by the hydrogen clearance method before, during, and after SCS. After the start of SCS in the high cervical cord with a frequency of 20 Hz, CBF gradually increased up to 140% of the pre-SCS value, and remained high for 15 min after the end of SCS. SCS of the low cervical or mid-thoracic cord under the same condition caused no significant increase in CBF. Nor did SCS of the high cervical cord with frequencies of 200 and 2,000 Hz increase CBF. No CBF increase was observed after SCS of the high cervical cord with 20 Hz when the dorsal column was sectioned at the medullo-cervical junction. These results suggest that the ability of SCS to increase CBF is peculiar to high cervical cord stimulation with moderately low frequencies.

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