scholarly journals The Challenging Clinical Management of Patients with Cranial Dural Arteriovenous Fistula and Secondary Parkinson’s Syndrome: Pathophysiology and Treatment Options

2020 ◽  
Vol 10 (3) ◽  
pp. 124-138
Author(s):  
Julia Velz ◽  
Zsolt Kulcsar ◽  
Fabian Büchele ◽  
Heiko Richter ◽  
Luca Regli
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Treatment Options ◽  
Internal Capsule ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
High Morbidity ◽  
Complete Regression ◽  
Pathophysiological Mechanism ◽  
Tentorial Sinus

Cranial dural arteriovenous fistula (cDAVF) may rarely lead to parkinsonism and rapid cognitive decline. Dysfunction of the extrapyramidal system and the thalamus, due to venous congestion of the Galenic system with subsequent parenchymal edema, is likely to represent an important pathophysiological mechanism. Here, we report a case of a 57-year-old man with a cDAVF of the straight sinus (Borden type III; DES-Zurich bridging vein shunt [BVS] type with direct, exclusive, and strained leptomeningeal venous drainage [LVD]) and subsequent edema of both thalami, the internal capsule, the hippocampi, the pallidum, and the mesencephalon. Several attempts at venous embolization were unsuccessful, and the neurological condition of the patient further deteriorated with progressive parkinsonism and intermittent episodes of loss of consciousness (KPS 30). A suboccipital mini-craniotomy was performed and the culminal vein was disconnected from the medial tentorial sinus, achieving an immediate fistula occlusion. Three-month follow-up MRI revealed complete regression of the edema. Clinically, parkinsonism remitted completely, allowing for tapering of dopaminergic medication. His cognition markedly improved in further course. The purpose of this report is to highlight the importance of rapid and complete cDAVF occlusion to reverse venous hypertension and prevent progressive clinical impairment. The review of the literature underlines the high morbidity and mortality of these patients. Microsurgical disconnection of the fistula plays an important role in the management of these patients and, surprisingly, has not been reported so far.

Endovascular treatment of complex dural arteriovenous fistula using the dual-microcatheter technique

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1 ◽  
Author(s):  
Michael R. Levitt ◽  
Joshua W. Osbun ◽  
John D. Nerva ◽  
Louis J. Kim
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Jugular Bulb ◽  
Endovascular Embolization ◽  
Venous Hypertension ◽  
Lost To Follow Up ◽  
Onyx Copolymer

A 71-year-old woman presented with headache and dilated vessels on CTA. Angiography demonstrated a complex dural arteriovenous fistula with retrograde cortical venous hypertension, supplied by branches of internal and external carotids bilaterally into a fistulous pouch paralleling the left transverse and sigmoid sinuses, which was occluded at the jugular bulb. The patient refused treatment and was lost to follow-up, returning with sudden confusion and hemianopsia from left temporo-occipital hemorrhage. Transvenous endovascular embolization was performed using the dual-microcatheter technique with a combination of coiling and Onyx copolymer, completely occluding the sinus and fistula while preserving normal venous drainage.The video can be found here: http://youtu.be/u_4Oc7tSmDM.

scholarly journals Endovascular Treatment of a Dural Arteriovenous Fistula of the Transverse Sinus by Recanalisation, Angioplasty and Stent Deployment

2003 ◽  
Vol 9 (1) ◽  
pp. 65-69 ◽  
Author(s):  
W. Weber ◽  
B. Kis ◽  
J. Esser ◽  
P. Berlit ◽  
D. Kühne
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Clinical Symptoms ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
Venous Reflux ◽  
Stent Deployment ◽  
Total Occlusion ◽  
Cortical Venous Reflux

We report the endovascular treatment of a 40-year-old woman with bilaterally thrombosed transverse sinuses and a dural arteriovenous fistula (DAVF) causing cortical venous reflux by recanalization, angioplasty and stent deployment of the occluded sinus segment followed by occlusion of the DAVF by stent deployment in the fistulous segment. By recanalization of the occluded sinus we re-established normal anterograde venous drainage and eliminated the venous hypertension and cortical venous reflux. After the procedure, the patient was treated with aspirin and clopidogrel for three months. A follow-up examination showed total occlusion of the DAVF, patency of the sinus and a complete resolution of the clinical symptoms.

scholarly journals Bilateral Cervical Spinal Dural Arteriovenous Fistulas with Intracranial Venous Drainage Mimicking a Foramen Magnum Dural Arteriovenous Fistula

2013 ◽  
Vol 19 (4) ◽  
pp. 483-488 ◽  
Author(s):  
Steven W. Hetts ◽  
Joey D. English ◽  
Shirley I. Stiver ◽  
Vineeta Singh ◽  
Erin J. Yee ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Foramen Magnum ◽  
Venous Hypertension ◽  
Complex Case ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Diagnostic Angiography ◽  
Spinal Dural Arteriovenous Fistulas

We describe a unique case of bilateral cervical spinal dural arteriovenous fistulas mimicking an intracranial dural arteriovenous fistula near the foramen magnum. We review its detection via MRI and digital subtraction angiography and subsequent management through surgical intervention. Pitfalls in diagnostic angiography are discussed with reference to accurate location of the fistula site. The venous anastomotic connections of the posterior midline spinal vein to the medial posterior medullary vein, posterior fossa bridging veins, and dural venous sinuses of the skull base are discussed with reference to problem-solving in this complex case. The mechanism of myelopathy through venous hypertension produced by spinal dural fistulas is also emphasized.

Spinal dural arteriovenous fistula presenting with paraplegia following lumbar puncture

2013 ◽  
Vol 19 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Guus Koerts ◽  
Vincent Vanthuyne ◽  
Maxime Delavallee ◽  
Herbert Rooijakkers ◽  
Christian Raftopoulos
Keyword(s):  
Arteriovenous Fistula ◽  
Lumbar Puncture ◽  
Dural Arteriovenous Fistula ◽  
Treatment Options ◽  
Venous Hypertension ◽  
Spinal Dural Arteriovenous Fistula ◽  
Segmental Artery ◽  
Arteriovenous Fistulas ◽  
Underlying Mechanisms ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas are rare lesions with an annual incidence of 1 per 100,000 population. In patients with this disease, an abnormal vascular dural shunt exists between a dural branch of a segmental artery and a subdural radicular vein that drains the perimedullary venous system, leading to venous hypertension and secondary congestive myelopathy. Generally, patients present with progressive paraparesis, urinary disturbances, and gait ataxia. In this report the authors describe a 61-year-old woman with a spinal dural arteriovenous fistula who developed an acute paraplegia after a nontraumatic lumbar puncture. The possible underlying mechanisms and treatment options are discussed.

Reversal of Diffusion Restriction After Embolization of Dural Arteriovenous Fistula: Case Report

Neurosurgery ◽  
2010 ◽  
Vol 67 (4) ◽  
pp. E1147-E1151 ◽  
Author(s):  
Guilherme Dabus ◽  
Richard A Bernstein ◽  
Michael C Hurley ◽  
Ali Shaibani ◽  
Bernard R Bendok ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Rare Case ◽  
Dural Arteriovenous Fistula ◽  
Clinical Presentation ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
Resonance Imaging ◽  
Diffusion Restriction ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND AND IMPORTANCE: We report a rare case of diffusion restriction caused by venous hypertension resulting from a dural arteriovenous fistula (DAVF) that completely reversed after successful embolization. CLINICAL PRESENTATION: A 54-year-old man presented with symptoms secondary to a DAVF. Magnetic resonance imaging (MRI) revealed left parieto-temporo-occipital diffusion restriction. The angiogram revealed a Cognard type III left lateral tentorial DAVF resulting in severe venous hypertension. Transarterial Onyx embolization was performed, resulting in angiographic cure of the fistula with normalization of the venous drainage in the left parieto-temporo-occipital region. A follow-up MRI examination performed 4 weeks after the embolization revealed resolution of the previously seen area of restricted diffusion. CONCLUSION: It is important to consider the possibility of diffusion restriction reversal, because misdiagnosis or the false assumption that irreversible cerebral infarction has occurred may inappropriately alter or delay the treatment of these aggressive lesions.

scholarly journals Intracranial Dural Arteriovenous Fistula Presenting with Tetraparesis Due to Cervicomedullary Junction Compression

2004 ◽  
Vol 10 (4) ◽  
pp. 347-351 ◽  
Author(s):  
S.M. Chng ◽  
Y.Y. Sitoh ◽  
F. Hui
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Venous Drainage ◽  
Foramen Magnum ◽  
Venous Hypertension ◽  
Good Reduction ◽  
Arteriovenous Fistulas ◽  
Cervicomedullary Junction ◽  
Dural Arteriovenous Fistulas ◽  
Glue Embolization

Cranial dural arteriovenous fistulas (DAVFs) may give rise to myelopathy due to spinal perimedullary venous drainage causing intramedullary venous hypertension. Such cases are uncommon but not rare, with several cases reported in the literature. We report a case of foramen magnum DAVF presenting with symptoms of tetraparesis. The unusual feature was that in this case it was due to compression of the cervicomedullary junction by a large venous pouch rather than the result of spinal perimedullary venous hypertension. Transarterial glue embolization achieved good reduction of flow in the fistula with shrinkage of the venous pouch and corresponding clinical improvement.

Central Venous Occlusion in End-Stage Renal Failure—A Rare Mimic of Dural Arteriovenous Fistula (DAVF)

2021 ◽  
Vol 4 (1) ◽  
pp. 81-83
Author(s):  
Sharath Kumar Goddu Govindappa ◽  
Lakshminarayanapuram Gopal Viswanathan ◽  
Shashidhar Kallappa Parameshwarappa ◽  
Naveen Nayak ◽  
Sujit Kumar ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Rare Complication ◽  
Venous Occlusion ◽  
Venous Hypertension ◽  
Brachiocephalic Vein ◽  
Central Venous ◽  
Av Fistula ◽  
Central Venous Occlusion ◽  
End Stage

Intracerebral hemorrhage is a devastating form of stroke and is more common in patients with hypertension and renal disease. We present the case of a lady suffering from chronic kidney disease who presented with severe headache and aphasia. On evaluation, she was found to have an intraparenchymal hemorrhage in the left temporal lobe with prominent pial and dural veins suggestive of a dural arteriovenous fistula (DAVF). Subsequently, she was detected to have occlusion of the left brachiocephalic vein (LBCV), which resulted in venous hypertension and resulted in this rare complication. Angioplasty followed by stenting of the LBCV resulted in subsidence of her symptoms. We wish to highlight this unusual but treatable complication of limb AV fistula which can mimic intracranial DAVF.

scholarly journals The remnant of primary head sinus found in the case of dural arteriovenous fistula: A case report

2016 ◽  
Vol 22 (4) ◽  
pp. 452-456 ◽  
Author(s):  
Katsuhiro Mizutani ◽  
Takenori Akiyama ◽  
Kazunari Yoshida
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Rare Condition ◽  
Venous Drainage ◽  
Petrous Bone ◽  
Jugular Bulb ◽  
Cone Beam ◽  
Middle Fossa ◽  
Rotational Angiography ◽  
Anatomic Information

In the embryo, the primary head sinus (PHS) is the first venous drainage channel in the craniocervical region. During embryonic development, this channel regresses and usually disappears completely; accordingly, a remnant of the PHS is an extremely rare condition and has been described in only a few previous studies. Here, we report a case of remnant of the PHS with a dural arteriovenous fistula (dAVF) in an adult. The remnant of the PHS had penetrated the petrous bone to run from the middle fossa to the jugular bulb and served as a drain for the middle fossa dAVF. We used digital subtraction angiography and reconstructed cone-beam computed tomography in 3D rotational angiography to obtain detailed anatomic information about the remnant PHS and additionally scrutinised and discussed its features.

Advances in Surgical Approaches to Dural Fistulas

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S32-S41 ◽  
Author(s):  
Patrick P. Youssef ◽  
Albert Jess Schuette ◽  
C. Michael Cawley ◽  
Daniel L. Barrow
Keyword(s):  
Treatment Options ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
Surgical Approaches ◽  
Dural Sinus ◽  
Intraoperative Angiography ◽  
Indocyanine Green Videoangiography ◽  
Arteriovenous Fistulas ◽  
The Past ◽  
Dural Arteriovenous Fistulas

Abstract Dural arteriovenous fistulas are abnormal connections of dural arteries to dural veins or venous sinuses originating from within the dural leaflets. They are usually located near or within the wall of a dural venous sinus that is frequently obstructed or stenosed. The dural fistula sac is contained within the dural leaflets, and drainage can be via a dural sinus or retrograde through cortical veins (leptomeningeal drainage). Dural arteriovenous fistulas can occur at any dural sinus but are found most frequently at the cavernous or transverse sinus. Leptomeningeal venous drainage can lead to venous hypertension and intracranial hemorrhage. The various treatment options include transarterial and transvenous embolization, stereotactic radiosurgery, and open surgery. Although many of the advances in dural arteriovenous fistula treatment have occurred in the endovascular arena, open microsurgical advances in the past decade have primarily been in the tools available to the surgeon. Improvements in microsurgical and skull base approaches have allowed surgeons to approach and obliterate fistulas with little or no retraction of the brain. Image-guided systems have also allowed better localization and more efficient approaches. A better understanding of the need to simply obliterate the venous drainage at the site of the fistula has eliminated the riskier resections of the past. Finally, the use of intraoperative angiography or indocyanine green videoangiography confirms the complete disconnection of fistula while the patient is still on the operating room table, preventing reoperation for residual fistulas.

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