Connection between a dural artery and a dural vein in a dural arteriovenous fistula of the cranial vault

A 41-year-old man presented with consciousness disturbance and right hemiparesis. Computed tomography showed a hematoma in the frontal lobe. Left carotid angiography showed a dural arteriovenous fistula (AVF) located in the cranial vault, supplied by the left middle meningeal artery, and drained directly into the cortical vein adjacent to the superior sagittal sinus. Emergency decompressive craniectomy and evacuation of the intracerebral hematoma were performed. A red vein was found on the cortex but the location of the arteriovenous shunt was not clear due to severe brain swelling. Two months later, cranioplasty was performed and a part of the dura mater, expected to have been affected by the dural AVF, was resected. Histological examination disclosed thickening of the intima of the middle meningeal artery and a few small veins around this artery. The fistula was clearly demonstrated between the dural artery and the dural vein. The non-sinal type of dural AVF may originate in similar arteriovenous connections to the sinal type.     

Traumatic arteriovenous fistula with feeders of the scalp, dura mater and pia mater: case report

A very rare case of 41-year-old male with symptomatic dural arteriovenous fistula which was detected after 22 years from receiving head injury is reported. This AVF had arterial blood supply of scalp, dural and pial origins. In the literature, only two similar cases have so far been reported. The draining veins were the superior sagittal sinus and the vein of Trolard, and a large vascular sac was seen in the pial vein.     

A case of vein of Galen aneurysmal malformation with a newly developed dural arteriovenous fistula after successful embolization

We report a case of vein of Galen aneurysmal malformation (VGAM) with a newly developed dural arteriovenous fistula (AVF) subsequent to successful embolization. A male neonate diagnosed as VGAM with prenatal ultrasonography and MRI presented severe cardiac and respiratory failure soon after birth. Five sessions of transarterial embolization using NBCA were performed during the first 6 months of his life. The shunt flow was effectively reduced and heart failure was resolved after the treatment. Follow-up angiography performed 2.5 years after the last embolization revealed complete obliteration of VGAM and newly developed small dural AVF on the wall of the thrombosed falcorial sinus. We believe that the dural AVF in this case was caused by local venous hypertension or induction of angiogenic factor during the thrombosing process of VGAM.     

Rendu-Osler-Weber disease with a giant intracerebral varix secondary to a high-flow pial AVF: case report

BACKGROUND: Intracranial varices are rare and most are associated with vein of Galen arteriovenous malformations (AVM) or fistulas (AVF). DESCRIPTION: A 43-year-old left-handed man presented with right hemihypesthesia and spastic gait. Neuroradiological examination revealed a spinal AVF and a giant intracerebral varix associated with a high-flow pial AVF. He had recurrent episodes of nasal bleeding, which were also confirmed in his mother's medical history, and telangiectases in the tip of his tongue and fingers. He was diagnosed with Rendu-Osler-Weber disease. After resection of the spinal AVF that produced his symptoms, we surgically exposed and obliterated the giant varix and AVF under intra- and postoperative hypotension and mild barbiturate therapy. The arteriovenous shunt was completely obliterated without hyperperfusion of the surrounding brain. CONCLUSION: This is an extremely rare case of Rendu-Osler-Weber disease with a giant intracerebral varix secondary to a high-flow pial AVF that did not involve the vein of Galen.     

Resolution of an anterior-inferior cerebellar artery feeding aneurysm with the treatment of a transverse-sigmoid dural arteriovenous fistula.

A 27-year-old man developed an unruptured anterior-inferior cerebellar artery (AICA) feeding aneurysm from a transverse-sigmoid dural arteriovenous malformation. The patient, with a known history of left transverse and sigmoid sinus thrombosis, presented with pulse-synchronous tinnitus. Angiography revealed an extensive dural arteriovenous fistula (AVF), with feeders from both the extracranial and intracranial circulations, involving the right transverse sinus, the torcula, and the left transverse/sigmoid sinuses. Multimodal endovascular and open surgical therapy was used to manage the lesion. Before a planned second-stage treatment for the left sigmoid sinus component, the dural AVF improved significantly. During this interval, however, a small flow-related aneurysm developed on the left AICA feeding the petrous dural region. The aneurysm resolved after resection of the involved sigmoid sinus. This is the first reported case of an unruptured feeding-artery aneurysm in an intracranial dural AVF that resolved spontaneously with treatment of the dural AVF. Until more is known about the natural history, the decisions of when and whether to treat an unruptured dural AVF feeding-artery aneurysm must be made on an individual basis.     

Acquired Pial and Dural Arteriovenous Fistulae following Superior Sagittal Sinus Thrombosis in Patients with Protein S Deficiency: A Report of Two Cases

Two patients with protein S deficiency with acquired multiple pial and dural arteriovenous fistulae (AVFs) following superior sagittal sinus (SSS) thrombosis are reported. Case 1 is a 38-year-old male with protein S deficiency who developed generalized seizure due to SSS thrombosis. Local fibrinolysis was achieved in the acute stage. His 10-month follow-up angiogram revealed an asymptomatic acquired dural AVF arising from the middle meningeal artery and the anterior cerebral artery with drainage to the thrombosed cortical vein in the right frontal lobe. Furthermore, his 2-year follow-up angiogram revealed a de novo pial AVF from the middle cerebral artery in the Sylvian fissure with drainage to the cortical vein initially thrombosed. However, this asymptomatic pial AVF caused bleeding in the ipsilateral cerebral hemisphere 12 years after onset, whereas the dural AVF spontaneously disappeared. Surgical disconnection was successfully performed to eliminate the source of hemorrhage. Case 2 is a 50-year-old male with a past history of SSS thrombosis with protein S deficiency who developed pulsatile tinnitus and generalized seizure. His angiogram showed a cortical dural AVF in the left parietal lobe and a sporadic dural AVF involving the right sigmoid sinus. The parietal lesion was eliminated by transarterial embolization followed by craniotomy. However, a de novo pial AVF emerged from the middle cerebral artery adjacent to the previously treated lesion. Of four cortical AVFs in two patients, thrombosis of cortical veins caused by protein S deficiency might play an important role in their formation. Long-term follow-up is required because this peculiar disorder has an unusual clinical course.     

Transarterial intravenous coil embolization of dural arteriovenous fistula involving the superior sagittal sinus

BACKGROUND

We report a rare case of traumatic dural arteriovenous fistula involving the superior sagittal sinus successfully treated by transarterial intravenous coil embolization.

CASE PRESENTATION

A 38-year-old woman presented with tension headache. She had a past history of severe head injury at the age of three. Computed tomography scanning showed a heterogenous low-density area in the right frontal lobe, and magnetic resonance imaging demonstrated abnormal vascular structures in the same area. Angiography revealed a dural arteriovenous fistula involving the lateral wall of the fully patent superior sagittal sinus. The fistula was fed by scalp, meningeal, and cortical arteries, and drained into a cortical vein leading to the superior sagittal sinus. Femoral transarterial intravenous embolization with microcoils completely occluded the dural arteriovenous fistula.

CONCLUSION

Severe head injury may lead to asymptomatic dural arteriovenous fistulas after a long time. Transarterial intravenous coil embolization can be effective in the treatment of dural arteriovenous fistulas involving the superior sagittal sinus.     

A case of secondary anterior fossa dural arteriovenous fistula following posterior fossa craniotomy

The etiology of dural arteriovenous fistula (AVF) remains uncertain. The authors present a case presenting with anterior fossa dural AVF, which developed after the resection of cerebellar arteriovenous malformation (AVM). The anterior fossa dural AVF, which was not observed on the preoperative angiography, was diagnosed on the follow-up angiography, after the resection of cerebellar AVM. A mechanism underlying the present case is not clearly understood. To the best of our knowledge, some cases of dural AVF secondary to craniotomy have been reported. It is postulated that intracranial vascular anomaly should be analyzed after the surgery.     

Progressive myelopathy caused by dural arteriovenous fistula at the craniocervical junction--case report.

A 68-year-old male presented an unusual dural arteriovenous fistula (AVF) located at the craniocervical junction. Magnetic resonance imaging revealed dilated perimedullary veins around the spinal cord at C-1 and C-2 levels, as well as high intensity signals in the spinal cord on T2-weighted images. Vertebral angiography identified an AVF at the point where the right vertebral artery penetrates the dura. The fistula was a single and direct communication between the vertebral artery and the spinal vein. Surgical interruption of the fistula at its venous side resulted in prompt improvement of both motor and sensory signs and symptoms.     

Dural arteriovenous fistula of the transverse sinus with concomitant ipsilateral meningioma

A 69-year-old female complained of headache and tinnitus. Computed tomography, magnetic resonance imaging, and angiography showed a tumour in the right transverse sinus extending to the transverse-sigmoid sinus junction, a dural arteriovenous fistula (AVF), and right transverse-sigmoid sinus thrombosis with the downstream from the right sigmoid sinus involved by the tumour. Right external carotid angiography showed the tumour to be supplied by many branches of the right occipital artery, the posterior branches of the middle meningeal artery, and the posterior auricular artery, and the dural AVF fed by the occipital artery and the meningeal branches of the right vertebral artery. She underwent surgery via a combined right supra- and infratentorial approach. The tumour had invaded and blocked the right transverse sinus, which was resected. After surgery the patient was free of headache and tinnitus was diminished. Histological examination found that the tumour was a fibrous meningioma and that the orifice of the vein at the transverse sinus was blocked by the tumour. Serial follow-up cerebral angiography 2 months after surgery showed no change in the AVF, but 9 months after surgery confirmed disappearance of the AVF. This AVF was caused by occlusion of the right transverse sinus by the meningioma and was an acquired lesion.     

Unusual giant cerebral venous varix associated with brain abscess: variant of hereditary hemorrhagic telangiectasia--case report

A 35-year-old man suffered secondary generalized tonic-clonic convulsions due to a large brain abscess. Neuroimaging incidentally revealed another tumor-like lesion. Cerebral angiography confirmed that the lesion was an unusual giant venous varix associated with a high-flow pial arteriovenous fistula (AVF) and showed one more small arteriovenous malformation (AVM). Pulmonary AVF, which can cause brain abscess, was also detected. Surgical ligation of the AVF and removal of the small AVM via individual craniotomies resulted in successful extirpation of the cerebrovascular malformations. Although the typical mucocutaneous symptoms were absent in this patient, the combination of arteriovenous anomalies was highly suggestive of hereditary hemorrhagic telangiectasia.     

Case of traumatic dural arteriovenous fistula presenting as an acute subdural hematoma and an intracerebral hematoma. A case report

A rare case of traumatic dural arteriovenous fistula presenting as an acute subdural hematoma and an intracerebral hematoma is reported. A 57-year-old man was admitted to our hospital complaining of aphasia and right hemiparesis. A CT on admission demonstrated a left frontotemporal subdural hematoma and an intracerebral hematoma in the left frontal lobe. Left external carotid angiographies revealed a dural arteriovenous fistula, fed by the left middle meningeal artery and draining the middle meningeal vein. A retrograde drainage into the cortical vein was also revealed. The patient had sudden loss of consciousness after cerebral angiography and demonstrated increased subdural hematoma and severe midline shift. We performed emergency decompressive craniectomy, coagulation of the dural vessels, and evacuation of the subdural hematoma. Postoperative left external carotid angiographies revealed the disappearance of the dural arteriovenous fistula. This case suggested a dural arteriovenous fistula, between the middle meningeal artery and the middle meningeal vein close to the sinus (sphenoparietal or superior sagital sinus), and resulted in a subdural hematoma and an intracerebral hematoma, due to the retrograde venous drainage into cortical veins.     

A case of bleeding dural arteriovenous fistula of the transverse-sigmoid sinus with pure leptomeningeal drainage,varix: case report

We reported a case of bleeding from the varix of a transverse-sigmoid sinus dural arteriovenous fistula with pure leptomeningeal drainage. A 55-year-old man presented with visual disturbance. neurological examination revealed left homonymous hemianopsia. CT scans demonstrated a subcortical hemorrhage in the right occipital lobe. Right external carotid angiograms showed a dural arteriovenous fistula of the transverse-sigmoid sinus fed by middle meningeal arteries and the occipital artery. The draining vein was the cortical vein with a varix. Transverse and sigmoid sinuses were patent. We concluded that the cause of the subcortical hemorrhage was a varix of the dural arteriovenous fistula. Initially, we embolized the dural arteriovenous fistula using a transarterial approach with GDC. Additionally, we interrupted the draining vein of the dural arteriovenous malformation. Angiographic cure was obtained and the postoperative course was uneventful. We discussed the clinical features, and the management of this case.     

A case of ruptured aneurysm of the middle cerebral artery associated with dural arteriovenous fistula in the anterior cranial fossa

A 66-year-old man suffered from subarachnoid hemorrhage due to the rupture of a right middle cerebral artery aneurysm that was detected by 3D-CTA. He underwent an emergent clipping operation. Incidentally, postoperative DSA demonstrated dural arteriovenous fistula in the left anterior cranial fossa, which was fed by the left anterior ethmoidal artery and drained into the superior sagittal sinus via the cortical vein of the left frontal lobe. We performed electrocoagulation and division of the fistula at the second surgery. Subsequently, he underwent a ventriculo-peritoneal shunt and was discharged without any neurological deficits. We reviewed reported cases of rare association of ruptured cerebral aneurysm and dural arteriovenous fistula in the left anterior cranial fossa.     

Arteriovenous fistula involving the inferior petroclival vein--case report

A 68-year-old man presented with an extremely rare extracranial arteriovenous fistula (AVF) involving the inferior petroclival vein (IPCV) with retrograde venous drainage into an ophthalmic vein through the anterior condylar confluence and inferior petrosal sinus manifesting as ocular symptoms. The AVF was successfully treated by selective transvenous embolization with platinum coils. AVF involving the IPCV should be recognized as a possible extracranial lesion manifesting as clinical symptoms similar to cavernous sinus dural AVF.     

Variant arteriovenous fistula of the superior sagittal sinus--case report.

A 57-year-old male presented with a rare variant of dural arteriovenous fistula, located in the wall of an unobstructed superior sagittal sinus. Drainage occurred through a cortical vein no longer connected to its parent sinus, which filled up a cluster of transmedullary running veins, one of which was the presumed site of hemorrhage. Arterial blood was supplied via the external carotid artery branches. This type of fistula seriously increases the risk of hemorrhage in the patient and therefore requires complete obliteration. Attempts to embolize the fistula failed. The draining vein was isolated and coagulated resulting in permanent occlusion of the fistula. The fistula probably developed through a process of thrombophlebitis and revascularization via arterioles of the vein rather than previous occlusion of the sinus.     

Subarachnoid hemorrhage caused by dural arteriovenous fistula of the sphenobasal sinus--case report

A 59-year-old woman presented with a rare middle fossa dural arteriovenous fistula (AVF) unrelated to the cavernous sinus manifesting only as subarachnoid hemorrhage. Angiography revealed shunts between the meningeal branches of both the internal and external carotid arteries and the sphenobasal sinus. The AVF drained into the superficial middle cerebral vein (SMCV) which had a varix and an anastomosis to a superior cerebral vein. The arterial supply vessels were eliminated surgically and the sinus was excised. Bleeding did not recur and there was no venous infarction. Dural AVF of the sphenoparietal sinus is associated with pulsatile exophthalmos and dural AVF of the sphenopetrosal sinus with tinnitus, but dural AVF of the sphenobasal sinus has no obvious symptom. Simple interruption of the SMCV at the penetration of the arachnoid membrane was possible because of the absence of a draining vessel to preserve AVF patency, but the arteries were eliminated in this patient to prevent formation of another AVF.     

Dural arteriovenous malformation associated with occlusion of the superior sagittal sinus--case report.

The authors report a rare case of dural arteriovenous malformation (AVM) associated with occlusion of the superior sagittal sinus. A 78-year-old female developed transient aphasia, followed by generalized convulsion. Common carotid angiography showed a dural AVM fed by the bilateral middle meningeal arteries, draining to the superior sagittal sinus, and sinus occlusion. 123I-single photon emission computed tomography demonstrated decreased blood flow in the bifrontal-parasagittal regions. Transcatheter embolization via the feeding arteries improved the cerebral blood flow around the lesion, and the symptoms disappeared.     

Spinal dural arteriovenous fistula with hematomyelia caused by intraparenchymal varix of draining vein

Background ContextHemorrhage that results from spinal dural arteriovenous fistula (Type I arteriovenous malformation [AVM]) is uncommon. There are some reports of subarachnoid hemorrhage and subdural hematoma caused by Type I spinal AVM, but there are few reported cases of hematomyelia caused by spinal dural arteriovenous fistula.PurposeTo describe an interesting patient who had hematomyelia caused by a dural arteriovenous fistula (Type I spinal AVM).Study designA case report.MethodsWe present a case of a 51-year-old man who presented acute onset epigastric pain, paraplegia, and sensory loss below his nipples. Magnetic resonance imaging and selective spinal angiogram demonstrated hematomyelia, subarachnoid hemorrhage, and spinal arteriovenous fistula fed by the right Th7 intercostal artery. By laminotomy of Th6–8, the varix-like draining vein and intramedurally hematoma were partially removed and the arterial supply was interrupted by coagulation of the right Th7 segmental artery.ResultsOne month after surgery, he regained movement against gravity at the left ankle and toe but no functionally significant improvement.ConclusionsIt must be kept in mind that spinal dural arteriovenous fistulas (Type I spinal AVM) has possibility of hematomyelia origin, despite the fact that it is extremely rare.     

Adult pial arteriovenous fistula and superior sagittal sinus stenosis: angiographic evidence for high-flow venopathy at an atypical location. Case report

The authors present the case of a 69-year-old man who suffered from bilateral cortical venous hypertension due to a brain pial arteriovenous malformation (AVM) with a high-flow fistula. The AVM became complicated by the development of a high-grade stenosis of the posterior superior sagittal sinus (SSS). A comparison of cerebral angiograms obtained at different times revealed that the severe SSS stenosis had developed within a 5-year period and was located distal to the nidus of the left parietal AVM nidus, away from the entrance of the dominant superior superficial cortical draining vein into the SSS. The high-flow fistula was occluded with detachable coils and the AVM nidus was further embolized with acrylic. The SSS stenosis was mechanically dilated by means of balloon angioplasty and stent placement. This case provides angiographic evidence to support the hypothesis that a pial arteriovenous fistula in an adult can cause high-flow occlusive venopathy in a major sinus within a relatively short time and that this acquired high-flow occlusive venopathy can develop at an atypical location distant from the nidus of the AVM.