A Large Galenic Dural Arterio-Venous Fistula in an Adult Managed Surgically: A Case Report.

Galenic dural arteriovenous fistulas (GDAVFs) are rare, high-risk vascular malformations within the vein of Galen (VoG), commonly acquired due to factors like venous thrombosis, trauma, or infection and often resulting in severe complications such as hemorrhage or neurological deficits. A 55-year-old female presented with pulsatile tinnitus and headaches, with computed tomography (CT) angiography revealing a Borden type III GDAVF with obstructive hydrocephalus. She underwent microsurgical interruption of the fistula via a posterior interhemispheric approach, achieving significant nidus reduction, though a residual fistula persisted. At 3-month follow-up, the patient remained asymptomatic. This case underscores the challenges of GDAVFs, where their deep anatomical location complicates treatment, often necessitating a combination of endovascular and microsurgical approaches. Moreover, it highlights the impact of socioeconomic factors on healthcare access, particularly in resource-limited settings, and emphasizes the need for tailored, multidisciplinary strategies to optimize outcomes.