J Cerebrovasc Endovasc Neurosurg.  2024 Dec;26(4):405-411. 10.7461/jcen.2024.E2024.05.001.

Convexity dural arteriovenous fistula with Sylvian-Labbé collateral pattern: A case report

• Yee PWS
• Kotaro T
• Kazutaka U
• Shinichi Y

• KMID: 2563090
• DOI: http://doi.org/10.7461/jcen.2024.E2024.05.001

Abstract

Convexity dural arteriovenous fistula (dAVF) is associated with high-grade dAVF and is usually presented with aggressive clinical presentation. Precise diagnosis and understanding the pathogenesis are important to achieving successful treatment without complications. We report a case of dAVF with Sylvian-Labbé collateral pattern, concerning embryological development that was thought to be involved in the vascular architecture and pathogenesis of dural AVF. Thus, a 60-year-old man was presented with sudden onset of seizure with no history of trauma. Magnetic Resonance Imaging (MRI) showed cortical hemorrhage in the left precentral gyrus. Digital subtraction angiography (DSA) showed the convexity dural arteriovenous fistula (dAVF) involving a vein that appeared to be the vein of Labbé, the drainer was anastomosed with superior middle cerebral vein (SMCV) and formed the varix. With the successful treatment with trans-arterial embolization (TAE), obliteration of dAVF was achieved with no neurological deficits. This case highlights convexity dAVF with the complex relationship between embryological development and the arcade of venous drainage route, wherein the anomaly might be acquired and caused by elevated venous pressure in a vein that appeared to be the vein of Labbé. Gaining knowledge of the embryological basis may aid in a deeper understanding of acquired pathologies.

Keyword

Dural arteriovenous fistula; Vein of Labbé; Dural sinuses

Figure

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  Fig. 1. (A), (B), (C), and (D) Left External carotid angiography (ECAG) arterial phase, left posterior convexity branch of middle meningeal artery (MMA) is the main feeder. Left transosseous branch of superficial temporal artery (STA) also gives blood supply as a feeder. Drainers are cortical veins going from the shunt point to both the ventral and dorsal regions. The ventral drainage anastomosed with superior middle cerebral vein (SMCV), while the dorsal drainage follows a hairpin curve near the transverse sinus (TS) and subsequently reconnects with the SMCV via the middle cranial fossa rote, forming the arcade. SMCV exhibits hairpin bend near the superior sagittal sinus (SSS) to form the varix, finally it drains into SSS. (E) Schematic presentation of the feeders and drainage route. (F) and (G) No obvious feeders are detected from the internal carotid artery. Cavernous sinus is not developed, and no other obvious venous obstruction has occurred.

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  Fig. 2. (A) and (B) Trans-arterial embolization (TAE) is performed via left middle meningeal artery using ONYX. (C) and (D), post operative common carotid angiography (CCAG) arterial phase, the shunt disappeared immediately after the TAE. (E) and (F), immediate post operative CCAG venous phase. Phase, there is no obvious disappearance of varix, but the early contrast disappearance has occurred. (G) and (H), follow-up internal carotid angiography (ICAG) venous phase, the varix completely disappeared after 3 months.

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  Fig. 3. (A) and (B) Left External carotid angiography (ECAG) arterial phase. Left posterior convexity branch of middle meningeal artery (MMA) and drainage course of the shunt (white arrowheads) which passes through the sphenobasal vein in middle cranial fossa and there is no connection with transverse sinus (TS). (A) Lateral view. (B) Anteroposterior (AP) view.

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