How should visual function monitoring be performed and interpreted in surgery for suprasellar tumors?

OBJECTIVE: Preservation of visual function is important in surgery for suprasellar tumors. Visual evoked potentials (VEPs) are expected to play an important role in monitoring visual function during surgery. Given the lack of information in this field, the authors aimed to investigate the effects of optic nerve compression caused by suprasellar tumors to understand the possible usefulness of VEP monitoring using off-response (OFR) VEP. METHODS: Eleven healthy volunteers who underwent surgery for standard record confirmation and 32 patients with optic chiasm lesions who underwent surgery were examined. Preoperative, postoperative, and intraoperative VEPs were recorded. Propofol anesthesia was administered during intraoperative VEP monitoring. Patients who underwent surgery were monitored using the same stimulation method during surgery. Light stimulation was given from a luminant pad on the eyelids, and low-intensity stimulation with continuous 500-msec emission and 500 msec off was performed. The luminescence intensity of the stimulation was at a maximum of 8000 lx with three attenuation steps, each of which was recorded repeatedly. RESULTS: The OFR potentials and delay latencies decreased as stimulus intensity decreased. In the patient with temporal hemianopia, monocular stimulation produced the highest OFR in the contralateral occipital lobe of the stimulated eye. The authors recorded preoperative, intraoperative, and postoperative VEP in 32 patients and observed intraoperative changes in 23 patients. In the cases where VEP declined during intraoperative recording, it recovered when surgery was discontinued. Furthermore, 3 patients eventually achieved a higher VEP than that achieved at the beginning of the surgery, and rapid recovery was confirmed with visual field examination immediately after surgery. Of the 5 patients in whom VEP did not recover during surgery, 3 showed decreased visual field and acuity after surgery. In 15 cases, potential dropped temporarily but returned to the original potential, and their visual field recovered after surgery. CONCLUSIONS: OFR has a diagnostic element in the visual field, in which the maximal potential was recorded on the opposite side of the stimulus with monocular stimulation. Unambiguous determination required stimulation of different intensities in both eyes or 1 eye and multiple recording electrodes placed in the occiput. Monitoring the OFR provides real-time alerts, making it a valuable tool for visual function evaluation in suprasellar surgery.

Where do the Fluorine Atoms Go in Inorganic-Oxide Fluorinations? A Fluorooxoborate Illustration under Terahertz Light.

The substitution of fluorine atoms for oxygen atoms/hydroxyl groups has emerged as a promising strategy to enhance the physical and chemical properties of oxides/hydroxides in fluorine chemistry. However, distinguishing fluorine from oxygen/hydroxyl in the reaction products poses a significant challenge in existing characterization methods. In this study, we illustrate that terahertz (THz) spectroscopy provides a powerful tool for addressing this challenge. To this end, we investigated two fluorination reactions of boric acid, utilizing MHF2 (M=Na, C(NH2)3) as fluorine reagents. Through an interplay between THz spectroscopy and solid-state density functional theory, we have conclusively demonstrated that fluorine atoms exclusively bind with the sp3-boron but not with the sp2-boron in the reaction products of Na[B(OH)3][B3O3F2(OH)2] (NaBOFH) and [C(NH2)3]2B3O3F4OH (GBF2). Based on this evidence, we have proposed a reaction pathway for the fluorinations under investigation, a process previously hindered due to structural ambiguity. This work represents a step forward in gaining a deeper understanding of the precise structures and reaction mechanisms involved in the fluorination of oxides/hydroxides, illuminated by the insights provided by THz spectroscopy.

Sternocleidomastoid muscle-splitting method for high cervical carotid endarterectomy: illustrative cases.

BACKGROUND: The number of cervical carotid endarterectomies (CEAs) has decreased as carotid artery stenting (CAS) has increased. However, CEA and CAS both have advantages and disadvantages; therefore, appropriate procedures must be selected for individual patients. High-positioned carotid artery stenosis presents technical challenges for CEA and is occasionally managed by performing CAS. However, CAS is associated with a high risk of thrombosis in patients with soft plaques, suggesting a clinical need for a better procedure. Consequently, appropriate surgical treatment for patients requiring high-level CEAs is essential. OBSERVATIONS: In this study, a novel and straightforward method was devised. The primary concept underlying this technique is separation of the sternocleidomastoid muscle (SCM) from other anatomical structures to ensure a wider surgical field. By anatomically separating the SCM into the sternal and clavicular head groups, the objective of the wider surgical field can be met. Herein, we report technical innovations in high-positioned carotid artery stenosis and evaluate their efficacy in two patients. LESSONS: In conclusion, high CEA surgery using this new method is valuable and may eliminate barriers to more advanced approaches.

Proposed imaging assessment score for aneurysmal subarachnoid hemorrhage correlated with prognosis: Shinshu Aneurysmal subarachnoid hemorrhage score.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (aSAH) imaging has been shown to correlate with prognosis. However, no numerical index of bleeding severity has been established. This study aimed to propose a new simple scoring system for computed tomography imaging of aSAH and to confirm its effectiveness in retrospective and prospective studies. METHODS: We devised an image evaluation system as an objective index. This system was established by scoring six items, with a maximum total of 19 points. Using this score, named the Shinshu Aneurysmal Subarachnoid Hemorrhage Score (S-score), we performed a retrospective study of 210 patients with aSAH at a single institution to confirm its efficacy. Age and World Federation of Neurosurgical Societies grades were adopted as other verification items, and the modified Rankin Scale was used for prognostic evaluation. A multicenter prospective study was then conducted to examine the function of the score by examining 214 patients with aSAH. RESULTS: In the retrospective study, the threshold of the S-score between good and poor prognoses was 9/19 points. The area under the curve by receiver operating characteristic analysis of the S-score was 0.819, suggesting efficacy, with an odds ratio (OR) of 1.291 (1.077-1.547). In the prospective study, the judgment capability of the S-score was evaluated with a sensitivity of 0.674, specificity of 0.881, positive predictive value of 0.789, negative predictive value of 0.804, false-positive ratio of 0.119, false-negative ratio of 0.325, positive likelihood ratio of 6.072, and negative likelihood ratio of 1.369. S-score showed a significant difference in prognosis. The OR was 1.183 (1.009-1.388). CONCLUSIONS: The scoring system could contribute to patient prognosis assessment. S-score and its prognostic formulas may serve as an objective source of information in the development of clinical medicine.

Evaluation of the effect of granule size of raw tableting materials on critical quality attributes of tablets during the continuous tablet manufacturing process using near-infrared spectroscopy.

OBJECTIVE: The effects of granule size of raw materials on tablet hardness (TH) and weight (TW) in the continuous tablet manufacturing process (CTMP) were investigated using near-infrared spectroscopy (NIRS). METHODS: Granule materials of different sizes were prepared by extrusion granulation from a standard granule formula powder containing lactose/starch and 4.5% acetaminophen. Large-, small-, and medium-sized granules were sequentially filled in a hopper, and tablets were produced continuously using a single-shot tableting machine. After arranging approximately 500 tablets in order, the tablets were subjected to NIRS. A total of 450 NIRS datasets were divided into three groups of 150 each (calibration, validation 1, and validation 2 datasets). RESULTS: The best fitted calibration models for predicting TH and TW were obtained, with sufficient accuracy, based on NIRS using the partial least squares regression, and comprised both physical and chemical information. The regression and loading vectors of the calibration models suggested that the models used to predict TH and TW involve physical information based on geometrical factors of the tablet and chemical information related to binder-related intermolecular interactions. CONCLUSIONS: The changes in the predicted value profiles of TH and TW using NIRS reflected the changes in the measured values depending on the raw granule size during CTMP.

Comparing integrated continuous process "LaVortex®" and conventional batch processes for the pharmaceutical manufacturing of acetaminophen oral dosage formulations: Challenges and pharmaceutical properties of the granular and tableted products.

LaVortex® was developed as a novel free-flow continuous granulation/drying (CGD) system. In this study, we compared the advantages and disadvantages of granules prepared by continuous and batchwise manufacturing systems. Granules containing 30 % acetaminophen were manufactured under various operating conditions using CGD system, with comparison granules manufactured using conventional batch systems that involve a combination of fluid bed granulation (FG), agitation granulation (AG), continuous drying, fluid bed drying, and/or shelf drying, after which the pharmaceutical properties of each type of manufactured granule were evaluated. Cumulative particle-size distributions were determined by sieving, powder flowabilities were determined by angle of repose measurements, and scanning electron microscopy was employed to examine granule morphologies. The CGD system produced fine-to-large spherical or ellipsoidal granules that exhibited excellent powder fluidities and tabletabilities that are almost identical to those of AG granules. Moreover, the CGD granules exhibited better powder flowability than the FG granules. The addition of water promoted CGD-granule growth and improved significantly powder flowability, and did a little in tabletability. Small spherical granules with good fluidity suitable for fine-particle-coating core materials, or large granules with excellent fluidity and tabletability, were prepared by adjusting the values of the elemental parameters of the CGD process.

A novel needle holder for suturing in a deep and narrow surgical field: a technical note.

Microvascular anastomosis is a standard procedure in neurosurgery that is applied to various lesions, such as those of ischemic disease and moyamoya disease. The depth of an anastomosis can be superficial or deep. At deeper sites, the procedure becomes challenging, as the operative field is usually narrow. Among the anastomotic approaches, suturing is the most challenging in a limited and deeper field. Additionally, since the suturing device is inevitably long, the delicate procedure becomes challenging. To overcome this technical difficulty and suture more efficiently, even in a narrow and deep field, the authors developed a needle holder, the REVOLD-HS, that allows rotational motion without moving the holder. This new needle holder is uniaxial and allows the forceps at the tip to be manipulated by operating the rotor in the hand. There is a mechanism for opening, closing, and rotating the holder via the surgeon's finger without moving the holder. Based on suture experiments in simulated blood vessels while using the holder, some situations may necessitate the use of this needle holder. This novel smart device may assist in deep vascular anastomosis in microsurgery, suturing of the carotid artery in carotid endarterectomy, and dural repair in endoscopic surgery.

Analytical Evaluation of Wet and Dry Mechanochemical Syntheses of Calcium-Deficient Hydroxyapatite Containing Zinc Using X-ray Diffractometry and Near-Infrared Spectroscopy.

Calcium-deficient zinc-containing calcium phosphate (ZnAP), which has sustained zinc release properties that are effective for treating osteoporosis, can be efficiently synthesized as a biomaterial through wet grinding. To elucidate the physicochemical mechanism of these mechanochemical syntheses, ground products were obtained from the starting material powder (S-CP), consisting of calcium hydrogen phosphate dihydrate (CHPD), calcium oxide (CaO), and zinc oxide (ZnO), by wet and dry grinding for 0-3 h in a centrifugal ball mill. The ground S-CP products were analyzed using powder X-ray diffraction (XRD) and near-infrared spectroscopy (NIRS); the crystal transformations and molecular interactions of the ground products were kinetically analyzed. The XRD and second-derivative NIRS results indicate that the S-CP is primarily transformed into ZnAP via amorphous solid formation in wet grinding, and the reaction follows a consecutive reaction model. In contrast, in dry grinding, the ground product of CHPD and CaO is transformed into an amorphous solid following an equilibrium reaction model; however, ZnO is predominantly not transformed and remains crystalline.

Real-Time Monitoring of Critical Quality Attributes during High-Shear Wet Granulation Process by Near-Infrared Spectroscopy Effect of Water Addition and Stirring Speed on Pharmaceutical Properties of the Granules.

To produce high-quality pharmaceuticals, a real-time monitoring method for the high-shear wet granulation process (HSWG) was developed based on near-infrared spectroscopy (NIRS). Samples consisting of lactose, potato starch, and hydroxypropyl cellulose were prepared using HSWG with varying amounts of purified water (80, 90, and 100 mL) and impeller speed (200, 400, and 600 rpm), which produces granules of different characteristics. Twelve batches of samples were used for the calibration and nine batches were used for validation. After drying, the median particle size (D50), tapped density (TD), and Hauser ratio (HR) were measured. The best calibration models to predict moisture content (MC), D50, TD, and HR were determined based on pretreated NIR spectra using partial least squares regression analysis (PLSR). The temporal changes in the pharmaceutical properties under different amounts of water added and stirring speed were monitored in real time using NIRS/PLSR. Because the most important critical quality attribute (CQA) in the process was MC, granule characteristics such as D50, TD, and HR were analyzed with respect to MC. They might be used as robust and simple monitoring methods based on MC to evaluate the pharmaceutical properties of HSWG granules.

Visualization of thrombus using iterative reconstruction and maximum intensity projection of thin-slice CT images.

OBJECTIVE: Iterative reconstruction (IR) is a noise reduction method that facilitates the synthesis of maximum intensity projection (MIP) from a larger number of slices while maintaining resolution. The present study aimed to analyze whether CT evaluation using IR and MIP is ideal for thrombus evaluation of large vessel occlusions in patients with acute ischemic stroke. METHODS: Three types of images for each patient were reconstructed and categorized into three groups: the "conventional group," evaluated using 0.5-mm slice CT, the "MIP group," evaluated using 0.5-mm slice CT processed with MIP, and the "IR + MIP group," evaluated with 0.5-mm slice CT processed with IR and MIP. Noise and image quality were evaluated with noise standard deviation (Noise SD) and contrast-to-noise ratio (CNR). Three experts evaluated the thrombus edge coordinates, made a visual assessment, and compared the data with the digital subtraction angiography (DSA) of the mechanical thrombectomy. RESULTS: Twenty-nine patients with cerebral infarction having large vessel occlusion were included in this study. The IR + MIP group had a lower Noise SD and a statistically higher CNR, leading to more favorable image evaluations. The thrombus assessment showed no inter-rater variability in thrombus edge identification, and the visual assessment and comparison with DSA were statistically better in the IR + MIP group. CONCLUSIONS: IR reduces noise and improves resolution. MIP in combination with IR facilitates visualization of thrombus.

Thyroid hormone decreasing after mechanical thrombectomy for cerebral infarction.

OBJECTIVE: Mechanical thrombectomy (MT) is an established treatment for large vessel occlusion in patients with cerebral infarction. The use of iodine contrast agent decreases thyroid hormone levels via the Wolff-Chaikoff effect. Low triiodothyronine (T3) syndrome caused due to severe illness status can contribute to decreased levels of thyroid hormones. Reportedly, a low T3 level is associated with poor prognosis in patients with cerebral infarction. This study aimed to clarify the changes in thyroid hormone levels in the acute phase after MT and the effects of the iodine contrast agent on these hormones. METHODS: This was a single-center, prospective, and single-arm trial. Thyroid stimulating hormone (TSH), free T3 (FT3), and free T4 (FT4) levels were tested on admission and 24 h postoperatively in patients who were approved for MT. RESULTS: A total of 37 patients were screened during the study period and 31 patients were enrolled in this study. Significant decreases were observed in TSH (P < 0.001) and FT3 (P < 0.001) levels 24 h after MT. Moreover, there was a correlation between the decrease in ratio of change in FT3 levels and the amount of iodine contrast agent used per body surface area (r = 0.43, P = 0.019), while no such correlations were detected for TSH and FT4. CONCLUSION: We demonstrated that TSH and FT3 levels decreased in the acute phase after MT and that FT3 levels were associated with the amount of iodine contrast agent used.

Scattered cerebral infarction in the corona radiata predicts worse outcomes.

OBJECTIVES: Intracranial branch atheromatous disease often results in progressive motor deficits in the lenticulostriate arteries (LSA). In some patients with LSA infarction, magnetic resonance imaging (MRI) revealed single lesions at the LSA origin from the middle cerebral artery spreading in a scattered manner toward the distal area. This study aimed to elucidate the clinical characteristics of such cases. MATERIALS AND METHODS: This was a single-center, retrospective study comprising 1,840 consecutive patients admitted to the Ina Central Hospital, Japan. Two neurologists selected patients with LSA infarctions on the basis of MRI data. Patients with a single mass of infarct lesion from the origin were classified as the single group, whereas patients with infarct lesions as a single mass at LSA origin but divided and independent as the infarct area extended distally were classified as the scattered group. We compared the clinical characteristics and outcomes in these groups. RESULTS: The single and scattered groups included 119 and 35 patients, respectively. We defined worsening as an increase of one point or more on the National Institute of Health Stroke Scale. Univariate analysis demonstrated that patients in the scattered group showed significantly more worsening after hospitalization compared with those in the single group (48.6% vs. 28.6%; p < .05). Moreover, this can easily lead to increased disease severity (p < .016). In a multivariate analysis, group (odds ratio, 2.5 [95% CI, 1.11-5.74], p < .03) was an independent predictor of symptom worsening. CONCLUSIONS: Scattered infarction in the corona radiata is an aggravating factor leading to worse outcomes.

Cavernous Sinus Swelling and Abducens Nerve Paresis Due to Intracranial Hypotension.

The most common neurological symptom of spontaneous intracranial hypotension (SIH) is abducens nerve paresis, and the precise pathophysiology is unclear. The accepted explanation is traction on the cranial nerves caused by the downward displacement of the cranial content. We herein report magnetic resonance imaging of SIH that can explain the mechanism underlying abducens nerve paresis. The cavernous sinuses were particularly thickened compared with the surrounding dura. This phenomenon can be explained by venous swelling, which can occur after leakage of cerebrospinal fluid in a closed cavity. This swelling pushes the abducens nerve up, which then causes abducens nerve paresis.

Mechanochemical Effect on Controlled Drug Release of Konjac Glucomannan Matrix Tablets during Dry Grinding.

To design a controlled drug release preparation based on a safe natural material, a Konjac glucomannan (KGM) mixture containing 16.0 w/w% calcium hydroxide (Ca(OH)2) was ground in a planetary ball mill for 0-120 min. The mechanochemical effect on the physicochemical properties of the KGM ground product was investigated by Fourier-transform infrared spectroscopy (FT-IR), powder X-ray spectroscopy, scanning electron microscopy with energy-dispersive X-ray spectroscopy, and drug release testing. The FT-IR spectra of the ground KGM indicated that the deacetylation reaction of KGM was accelerated in the Ca(OH)2-containing sols by mechanochemical energy, and the degree of deacetylation of KGM was dependent on the grinding time. The time required for tablet disintegration of the KGM matrix tablets containing theophylline increased as the grinding time increased; therefore, drug release was sustained. The Higuchi plots of the matrix tablets obtained from KGM ground for 60-120 min exhibited good linearity because they maintained their gel matrix tablet shape during the release test. However, KGM tablets ground for 0-30 min exhibited nonlinear curves, which were caused by tablet disintegration. This suggests that drug release from the KGM matrix tablet can be freely controlled by the degree of mechanochemical treatment.

Comparative study on the real-time monitoring of a fluid bed drying process of extruded granules using near-infrared spectroscopy and audible acoustic emission.

The process of fluidized bed drying of granules was comparatively evaluated by on-line real-time measurements of granule moisture content (MC) using near-infrared spectroscopy (NIR) and audible acoustic emission (AAE). The extruded granules were prepared by kneading a powder blend containing lactose, starch, crystalline cellulose, and riboflavin, with water. The MC of the granules (while they were dried at 35 °C in a fluidized bed dryer) was monitored simultaneously with NIR and AAE. The prediction accuracy of the NIR and AAE using partial least squares (PLS) was verified by measuring MC of the granules. The best calibration models following NIR and AAE evaluations consisted of five latent variables with correlation coefficients of 1.000 and 0.998 and root mean square error of 0.259 and 0.615, respectively. As a result of external verification, the accuracy of MC analysis by AAE was slightly lower than that of NIR; however, it was still applicable in practice. Furthermore, the end point of fluidized bed drying process was automatically determined using the PLS discriminant analysis. From the above results, it can be concluded that the AAE-mediated granule drying process can be monitored with sufficient accuracy (compared with NIR).

A Case of Intraosseous Petrous Bone Arteriovenous Fistula Complicated by Transient Worsening of Ipsilateral Hearing Following Transvenous Coil Embolization.

Objective: We report a rare case of intraosseous arteriovenous fistula (AVF) in the petrous bone occluded by transvenous coil embolization, complicated by transient hearing loss postoperatively. Case Presentation: A 55-year-old female patient underwent medical examination for vertigo and headache. CT showed an osteolytic lesion in the right petrous bone. CTA and DSA revealed an AVF that had caused bone erosion. We performed transvenous coil embolization to obtain complete occlusion of the fistula. Vertigo disappeared soon after the procedure, but hearing loss in the right side worsened to near deafness by that night. We started steroid pulse therapy and heparinization. The hearing gradually recovered to the preoperative level in 10 days. Conclusion: It is important to pay attention to possible hearing loss in cases of transvenous coil embolization for intraosseous AVF in the petrous bone.

Comparison Between Conventional Flash and Off-Response Intraoperative Visual Evoked Potential Monitoring for Endoscopic Endonasal Surgery.

BACKGROUND: Intraoperative flash stimulation visual evoked potential (VEP) monitoring has been used for endoscopic endonasal approach (EEA). Recently, off-response VEP, which is recorded when the light stimulus is turned off, was introduced to monitor visual function intraoperatively. OBJECTIVE: To evaluate off-response VEP monitoring in comparison with the conventional flash stimulation VEP monitoring for EEA. METHODS: From March 2015 to March 2020, 70 EEA surgeries with intraoperative VEP monitoring (140 eyes) were performed. Light stimuli were delivered by a pair of goggle electrodes. Recording electrodes were placed on the scalp over the occipital region. The warning signal was prompted by a reduction of the peak-to-peak amplitude of the VEP by more than 50% compared to the initial amplitude. Visual function was assessed pre- and postoperatively. Results of flash and off-response VEP monitoring were compared. RESULTS: VEP was recorded in 134 eyes. Warning signal occurred in 23 eyes (transient in 17 eyes and permanent in 6 eyes). Two eyes showed permanent VEP attenuation for flash VEP monitoring, in which one patient had postoperative visual function deterioration. Four eyes showed permanent VEP attenuation for off-response VEP monitoring, where 2 patients had postoperative visual function deterioration. Sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 98.9%, 50%, and 100%, respectively, for flash stimulation VEP, and 100%, 97.8%, 50%, and 100%, respectively, for off-response VEP. CONCLUSION: VEP monitoring was useful to monitor visual function in EEA surgery. Off-response VEP monitoring was not inferior to conventional flash stimulation VEP monitoring.

Injection-Molded Coamorphous Tablets: Analysis of Intermolecular Interaction and Crystallization Propensity.

The processing steps involved in converting from a powder to a tablet entail numerous operations in a which the coamorphous system is recrystallized and dissociated easily. This research focused on (i) a single-step preparation of a coamorphous tablet during injection molding (IM) from the bulk powder, and (ii) a mechanistic characterization of the coamorphous formulation. We selected several organic acids [citric acid, succinic acid, tartaric acid, and malic acid] in an effort to compound with basic loratadine (a poorly water-soluble drug). Loratadine-acids coamorphous tablets were produced via an IM process, and the dissolution was more enhanced than in the pure loratadine amorphous. The interaction was analyzed by FT-IR and terahertz spectroscopies. Each tablet was stored at 40 °C/75%RH, and then XRD patterns were acquired at the desired timepoints. In summary, loratadine exhibited ionic interaction with each acid, and the physical stability of the coamorphous tablet was in proportion to the loratadine-acids interaction strength. Terahertz spectra detected the molecular mobility, which plays an important role in the crystallization propensity of a coamorphous system. This understanding offers a framework for robust coamorphous tablet formulation using the IM methodology.

Persistent Working Memory Impairment Associated with Cerebral Infarction in the Anterior Cingulate Cortex: A Case Report and a Literature Review.

A 52-year-old man experienced sudden-onset global amnesia and left limb ataxia. An embolism of the right anterior cerebral artery resulted in anterior cingulate cortex (ACC) infarction, and working memory dysfunction persisted. The ACC, prefrontal cortex, and bilateral superior parietal lobule exhibited decreased activity on single-photon emission computed tomography (SPECT). The ACC handles working memory formation and is essential for the executive function. The areas showing a decreased activity on SPECT were responsible for the working memory, which corresponded to the observed symptoms. This is the first case in which limited ACC infarction resulted in permanent working memory dysfunction, and SPECT revealed the decreasing working memory in the associated region.

A Case of Dural Arteriovenous Fistula in the Falx with Prominent Falcine Venous Plexus.

Objective: The falx cerebri is known to have venous plexuses. Although some cases of dural arteriovenous fistula (DAVF) associated with falcine sinus have been reported, DAVF in the falx with prominent falcine venous plexus has not previously been reported. Case Presentation: A 59-year-old male was hospitalized with head trauma. MRI incidentally showed a possible occipital DAVF. CTA and DSA revealed a DAVF in the flax with prominent falcine venous plexus. We performed a selective transarterial embolization with glue and particle, obtaining a complete occlusion of the fistula. Conclusion: We report a rare case of DAVF in the flax with prominent falcine venous plexus that was successfully treated by a transarterial embolization.