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De Novo Dural Arteriovenous Fistula on Draining Veins of Previously Treated Pial Arteriovenous Malformation: a Case Report.
Authors:Francesco Diana  Luigino Tosatto  Nicolò Haznedari  Christian Commodaro  Maria Ruggiero
Affiliation:2. Department of Neurosurgery, AUSL Romagna, M.Bufalini Hospital, Cesena, Italy;3. Department of Neuroradiology, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy;2. Department of Neurology, University of Florida, Gainesville, USA;2. Department of Neurosurgery, Nara Medical University, Kashihara, Japan;2. Department of Radiology, Paris Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 46 rue Henri Huchard, INSERM U1148, Paris 75018, France;3. Medical and Toxicological Intensive Care Unit, Lariboisière - Saint Louis hospital, Paris, France ; Assistance Publique - Hôpitaux de Paris, Paris University, Paris, France;2. School of Medicine, New York Medical College, Valhalla, NY, USA;2. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy;3. Laboratory of Clinical Pathology and Toxicology, Department of Laboratory Medicine, Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy;4. Neuroradiology Unit, Department of Neuroscience, Ospedale Civile, Azienda Ospedaliera Universitaria di Modena, Modena, Italy;5. Stroke Unit, Department of Neurology, Hospital Vall d''Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
Abstract:A 71-year-old man, with a pial micro-arteriovenous malformation (pAVM) draining into the confluence of the vein of Trolard and the vein of Labbé was surgically removed, sparing these cortical veins. 4-months MR and angiographic controls showed a de novo dural arteriovenous fistula (dAVF) draining into the previously spared cortical veins. It was removed using intraoperative motor evoked potentials (MEP). This is the first case of iatrogenic dAVF developing on the same draining vein of a previously treated pAVM. De novo dAVFs are generally iatrogenic. This case suggests that the unresected venous drainage of an AVM might be the substratum for neo-angiogenetic processes; moreover inflammation related to surgery might be the trigger factor for the development of the dAVF.
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