Development of a complex dural arteriovenous fistula next to a cerebellar developmental venous anomaly after resection of a brainstem cavernoma. Case report and review of the literature.
Developmental venous anomalies (DVAs) are common abnormalities of intracranial venous drainage, which may occur in conjunction with other cerebral vascular malformations and are known for their benign natural history. The authors present the case of a 16-year-old boy who experienced a spontaneous brainstem hemorrhage due to a cavernoma. Preoperative angiography findings revealed a large DVA draining the right cerebellar hemisphere. The patient underwent suboccipital surgery for cavernoma resection and recovered completely from his neurological symptoms. Fourteen months later he returned with progressive symptoms. Repeated angiography demonstrated a complex dural arteriovenous fistula (DAVF) of the transverse sinus, which had developed next to the DVA. Several transarterial and transvenous embolizations were ineffective. Common causes of acquired DAVFs and the potential role of the DVA in the development of the DAVF in this case are discussed on the basis of the pertinent literature.
Dudeck
Oliver
O
Department of Neurosurgery, Section of Neuroradiology, University of Freiburg, Germany. oliver.dudeck@charite.de
van Velthoven
Vera
V
Schumacher
Martin
M
Klisch
Joachim
J
D000086:Acetazolamide / Q000627:therapeutic use; D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000150:complications* / Q000601:surgery; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D002526:Cerebellar Diseases / Q000150:complications* / Q000151:congenital / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D004232:Diuretics / Q000627:therapeutic use; D004621:Embolization, Therapeutic / Q000379:methods; D020786:Hemangioma, Cavernous, Central Nervous System / Q000150:complications* / Q000601:surgery; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D016896:Treatment Outcome
D004232:Diuretics; D000086:Acetazolamide