J Korean Neurosurg Soc.  2022 Jul;65(4):598-602. 10.3340/jkns.2021.0144.

Occurrence of De Novo Dural Arteriovenous Fistula after Transvenous Embolization of Dural Arteriovenous Fistula : Case Reports of Two Patients

• Makita I
• Kamio Y
• Hiramatsu H
• Kurozumi K

• KMID: 2531629
• DOI: http://doi.org/10.3340/jkns.2021.0144

Abstract

Development of de novo dural arteriovenous fistula (DAVF) at a different site after resolution of an initial DAVF, is rare. Here we report two cases, which we encountered in our hospital. A 68-year-old woman presented with pulsatile tinnitus on the left side. Cerebral angiography demonstrated a left anterior condylar confluence (ACC) DVAF and she underwent transvenous embolization. Four years after this treatment, she presented with tinnitus on the left side, and cerebral angiography revealed a right DAVF around the sinus of the lesser sphenoid wing. Another 69-year-old woman presented with left-sided orbital bruits, chemosis, and conjunctival hyperemia. Cerebral angiography showed left cavernous sinus (CS) DAVF, for which she underwent transvenous embolization for CS DAVF. One year later, she developed a left ACC and transverse-sigmoid sinus (TSS) DAVF.

Keyword

Dural arteriovenous fistula,; Endovascular; Therapeutic embolization

Figure

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  Fig. 1. Right ascending pharyngeal artery angiogram demonstrates a left anterior condylar confluence dural arteriovenous fistula (DAVF) draining to left internal jugular and vertebral venous plexus (A, arrow). Postoperative cerebral angiogram demonstrates obliteration of the DAVF (B). Three-dimensional digital subtraction angiogram demonstrates that the DAVF (asterisk) around the sinus of the lesser sphenoid wing (SLSW) is mainly fed by the accessory meningeal artery. The DAVF drains from the SLWS through the sphenopetrosal vein and superior petrosal sinus into the inferior petrosal sinus via the cavernous sinus (dotted arrow) (C). The maximum intensity projection image on cerebral angiogram shows that retrograde leptomeningeal venous drainage is refluxed from the SLSW (white arrowhead) to the superficial middle cerebral vein (double arrowhead) via a bridging vein (white arrow) (D). Postoperative cerebral angiogram shows complete remission of the DAVF (E). SMCV : superficial middle cerebral vein, CS : cavernous sinus, SPV : sphenopetrosal vein, SPS : superior petrosal sinus, AMA : accessory meningeal artery, IPS : inferior petrosal sinus.

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  Fig. 2. Cerebral angiogram demonstrates that the left cavernous sinus dural arteriovenous fistula (DAVF) (asterisk) drains to the superficial middle cerebral vein (black arrow) (A). Postoperative cerebral angiogram shows that the fistula is occluded (B). Three-dimensional digital subtraction angiogram shows that the left anterior condylar confluence and transverse-sigmoid sinus (asterisks) DAVFs are mainly fed by the left ascending pharyngeal artery (APA) and middle meningeal artery (MMA) and drain to the left internal jugular vein without dangerous cortical venous reflux (dotted arrow) (C). Cerebral angiogram shows that the DAVFs are spontaneously are occluded (D). TSS : transverse-sigmoid sinus.

Reference

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