Dural arteriovenous malformation in the falx with subarachnoid hemorrhage

A case of falx dural arteriovenous malformation was reported. A 62 year old man was admitted to Nakamura City Hospital on August 15, 1989, with severe headache as his chief complaint. On admission, his consciousness was lethargic. CT scan showed subarachnoid hemorrhage with ventricular perforation and hematoma of the corpus callosum. Angiograms demonstrated a dural arteriovenous malformation (DAVM) in the frontal falx, which was fed by bilateral middle meningeal arteries and the left anterior falx artery and drained into the superior sagittal sinus via the dural vein. Bifrontal craniotomy was performed. At first, bilateral middle meningeal arteries were coagulated, and the frontoparietal dura was excised widely. Then, the falx was cut at the crista galli. The DAVM was found in the falx, including a vascular sac embedded in the brain tissue. The DAVM was coagulated as much as possible. Carotid angiograms revealed complete disappearance of the DAVM, 4 months after the operation. Although angiograms performed after only one month still showed a small residual DAVM. On reviewing the literature we found only 5 patients with the DAVM in the falx. In 6 cases including our own, intracranial hemorrhage occurred in 4 cases (3 cases were subarachnoid hemorrhage). Vascular sacs were seen in 4 cases, and drainage to the pial vein was noted in 3 cases. It seemed to be rare that the DAVM drained into the dural vein. In our particular case, operative findings showed the DAVM drained into the dural vein without the pial vein, and intracranial hemorrhage was attributed to rupture of the vascular sac.     

Dural arteriovenous malformation in the anterior cranial fossa: report of a case

We present an unusual case involving intracranial arteriovenous malformations in the anterior cranial fossa located symmetrically on both sides. A mixed pial and dural arteriovenous malformation, the nidus of which was localized in the brain parenchyma, was found on the right side and a pure dural arteriovenous malformation on the left side. Our case is felt to support the hypothesis of a congenital origin for dural arteriovenous malformation in the anterior cranial fossa, because the dural arteriovenous malformation coexisted with the mixed pial and dural arteriovenous malformation, which can be attributed to a disturbance of normal embryonic development.     

Dural arteriovenous malformation in the cervical spine presenting with subarachnoid hemorrhage: case report.

Most spinal dural arteriovenous malformations are located in the thoracic and lumbar regions. The symptoms include pain, weakness, sensory disturbances, and sphincter dysfunction, which are usually gradual in onset. They are attributed to venous hypertension with a resultant ischemia of the cord, and hemorrhage from them is rare. The authors report an unusual case of a patient with a dural arteriovenous malformation in the cervical spine who was admitted with a sudden onset of severe headache and dysesthesia due to subarachnoid hemorrhage.     

Dural arteriovenous malformations in the anterior cranial fossa

Summary Two cases of dural arteriovenous malformation (DAVM) fed by the anterior ethmoidal artery in the anterior cranial fossa are reported, one of them examined by magnet resonance imaging (MRI). Only one other case with MRI findings so far has been published. Fourty-eight previously reported cases are reviewed.One of our patients presented with subdural haematoma (SDH) without subarachnoid or intracerebral haemorrhage. The other patient had a nasal bleed without any neurological manifestations. In comparison with previously reported cases, the clinical manifestation of our cases is infrequent (1 patient with nasal bleed, and 2 patients with pure SDH that is 2 and 4%, respectively, in the literature). Feeder was the anterior ethmoidal artery either unilateral or bilateral. Drainage of DAVMs was through a markedly dilated vascular sac into the superior sagittal sinus (SSS). The high incidence of haemorrhage from DAVM in the anterior fossa is related to this vascular sac. Magnetic resonance imaging (MRI) showed a flow void area in the left frontal region on T 1-weighted images in one case.These cases were treated by surgical excision of the malformation with good results. Aetiology, clinical presentation, and treatment of these rare DAVMs in the anterior cranial fossa is discussed.     

Dural arteriovenous malformations in the anterior cranial fossa

Two elderly patients with dural arteriovenous malformations in the anterior cranial fossa are reported. These patients experienced rupture of the malformations at the age of 73 and 87 years. Surgical excision of the malformation was carried out on the younger patient. In the other case megavoltage x-ray therapy was applied because radical operation was not prudent. A search of the literature provided 26 other cases of this malformation involving the anterior cranial fossa. These are the first cases of rupture of arteriovenous malformation in the anterior fossa in patients over the age of 70.     

Two cases of spinal arteriovenous malformation presenting with subarachnoid hemorrhage

Two cases of spinal arteriovenous malformation (AVM) with subarachnoid hemorrhage (SAH) are reported. The first case is that of a 14-year-old boy who was transferred to our hospital with a sudden onset of headache. Neurological examination revealed no motosensory deficit, but a brain CT showed a slight diffuse SAH. A left vertebral angiogram demonstrated intramedullary AVM in the cervical region of the spinal cord. This AVM was therefore occluded using a solid embolization material. The patient was then discharged without neurological deficit. The second case is that of a 67-year-old man who visited our hospital with a sudden onset of headache. Neurological examination revealed no motor or sensory deficit, but a brain CT showed SAH, which was dominant in the posterior fossa. Initial cerebral angiography demonstrated no abnormality such as cerebral aneurysm or AVM except for laterality of the C1 radiculo-meningeal artery. A second angiogram on day 11 demonstrated spinal arteriovenous fistula (AVF), which was fed by the left radiculo-meningeal artery and drained to the posterior spinal vein. Embolization for the AVF was performed using liquid material. He was then discharged without neurological deficit. These two cases revealed non-specific SAH symptoms and were indistinguishable from other ruptured aneurysms. Although the brain CT can show a slight SAH or posterior fossa dominant SAH, repeated angiography may be necessary to verify and conclude the diagnosis of spinal AVM.     

Dural arteriovenous malformation in the posterior fossa associated with intracerebellar hematoma. Case report

A case of an infratentorial dural arteriovenous malformation associated with an intracerebellar hematoma is reported. This malformation was fed by meningeal branches of the right vertebral artery and was drained exclusively by pial veins in the posterior fossa.     

A case of dural arteriovenous malformation in the anterior fossa

Dural arteriovenous malformations (AVMs) are not uncommon. But most of dural AVMs are located in the cavernous portion or the transverse-sigmoid portion. Dural AVMs in the anterior fossa and very rare. We experienced a case of dural AVM in the anterior fossa and review 17 cases of dural AVM in the anterior fossa in the literature. Case: a 62-year-old male was admitted to our center because of unconsciousness and vomiting on Sept. 28; 1985. For nineteen months he had been on anticoagulant therapy after aorto-coronary bypass. Neurological examination on admission revealed somnolence and right-hemiparesis. CT scan revealed intracerebral hematoma in the left frontal lobe with ventricular perforation. Enhanced CT scan revealed patchy enhancement in the tip of the left frontal lobe. Selective angiographies were performed. Dural AVM, fed by both anterior ethmoidal arteries and drained by the cortical veins into the superior sagittal sinus and left superficial middle cerebral vein, was found. Selective external carotid angiography failed to visualize any AVM. MRI revealed spotty low signal intensity in the frontal tip by inversion recovery and spin echo. After admission his consciousness and right-hemiparesis improved completely. Left frontal craniotomy was done. On opening the dura, aneurysmal dilatation was found in the left frontal lobe, arising from the inner surface of the dura at the antero-medial corner of the left anterior fossa. From this aneurysmal dilatation a few veins entered the superior sagittal sinus. Red veins including aneurysmal dilation was removed from its origin together with the intracerebral hematoma. (ABSTRACT TRUNCATED AT 250 WORDS)     

Two surgically treated cases with dural arteriovenous malformation in the anterior cranial fossa

Dural arteriovenous fistulae(dAVF) in the anterior cranial fossa comprise about 6% of all dAVFs, and is usually detected after intracranial hemorrhage. However, non-hemorrhagic symptoms are uncommon. We encountered two patients with hemorrhagic and non-hemorrhagic dAVF in the anterior cranial fossa. Both cases were successfully treated using craniotomy and histopathological examination was performed. A 71-year-old male experienced sudden onset of nausea and headache, followed by progression of left hemiparesis and disturbance of consciousness due to intracerebral and subdural hematoma in 2005. Intracerebral venous aneurysm adjacent to the intracerebral hematoma originated from the draining cortical red vein was identified and successfully treated by operation. Histopathological examination revealed disappearance of the internal elastic lamina and scant muscle tissue in the venous aneurysmal wall originating from draining cortical vein. A 69-year-old male suffered sudden onset of mild headache, followed by progression of bruits in 2005. MRI suggested dAVF in the left anterior cranial fossa. 123I-IMP SPECT revealed an area of low perfusion in the left frontotemporal region. Histopathological examination after surgical treatment revealed thickening of the intima and an indistinct lamina elastica interna, indicating progressive degenerative changes of the arterialized vein likely to result in hemorrhage. Surgical obliteration of fistulae is reasonable even in the dAVF of the anterior cranial fossa with ischemic onset.     

Dural arteriovenous malformation with false aneurysm and exophthalmos

Summary A case of dural arteriovenous malformation with giant non-traumatic false aneurysm in the left middle fossa is reported.A 10-year-old female patient was admitted to our hospital with pulsating exophthalmos of the left eye, which was successfully treated by ligation of the main feeder and finally by the radical excision of the dural AVM and false aneurysm. False aneurysm of non-traumatic origin is so rare that only two cases were detected in the literature (Reinaet al., Sakakiet al.), and no previous case of false aneurysm complicated by dural AVM seems to have been reported.Presented in part at the 82nd Regular Meeting of the Hirosaki Medical Society, Hirosaki, Japan, 15. December 1975.     

Dural arteriovenous malformation secondary to meningioma removal

A unique case of dural arteriovenous malformation developing far from the site of a previously removed meningioma is reported. The AVM was successfully treated by emobilisation. The possible etiological factors are discussed.     

Cranio-cervical junction dural arteriovenous malformation presenting with subarachnoid hemorrhage: report of two cases

Most spinal dural arteriovenous malformations (AVMs) affect the thoracic and lumbar regions. The clinical features of dural AVMs are, usually, gradually progressing myelopathy, while hemorrhage is a rare occurrence. We have recently encountered two cases of cranio-cervical junction dural AVM which caused subarachnoid hemorrhage. Both patients, a 61-year-old and a 37-year-old man were admitted to our hospital due to sudden onset of severe headache. Left vertebral angiography demonstrated a dural AVM at the cranio-cervical junction. A left suboccipital craniotomy and left hemilaminectomy of the atlas were performed. Dural opening disclosed tortuous dilated abnormal vessels. The dural AVM was fed by multiple small dural branches of the left vertebral artery and drained into an intracranial pial vein. The dura where the left vertebral artery penetrated was coagulated and divided from the left vertebral artery. Postoperative courses of these patients were uneventful. The pathophysiology and surgical treatment of dural AVMs in the cranio-cervical junction are discussed.     

Dural arteriovenous fistula manifesting as subarachnoid hemorrhage at the craniocervical junction. A case report

A 65-year-old man suddenly developed severe headache, vertigo, and sensory disturbance of the right side. On the CT, a high density round mass was identified in the dorsal portion of the pons. The patient's level of consciousness decreased one hour later. A repeat CT showed diffuse subarachnoid hemorrhage and hydrocephalus. Angiography demonstrated a dural arteriovenous fistula (DAVF) at the craniocervical junction. The main feeding artery was the left C2 radicular artery, and the fistula was drained by a leptomeningeal vein that proceeded upward and had a venous ectasia in its distal portion. Transarterial embolization could not be performed because the feeding artery could not be cannulated using a microcatheter. 3D-CT angiography showed a single draining vein at the anterior portion of the left vertebral artery. Four weeks later, ventricular drainage was instituted following surgical disruption of the arteriovenous fistula's draining vein. Postoperative angiography demonstrated complete obliteration. In the present case, surgical clipping of the draining vein was safe and effective; surgical resection of the DAVF or cautery of the surrounding dura was not necessary. Intraoperative digital subtraction angiography (DSA) was as useful as the Doppler technique.