title: [A case of multiple dural arteriovenous fistulas treated by multiple modalities].
abstract: The authors report a rare case of multiple intracranial dural arteriovenous fistulas (DAVF) at separate sinuses. A 70-year-old man was introduced to our hospital complaining of visual disturbance due to bilateral choked disk, headache, and tinnitus. Initial angiography showed DAVFs involving the superior sagittal sinus and bilateral transverse-sigmoid sinuses, and the occlusion of the right jugular vein. The patient developed progressive impairment of visual activity and had high intracranial pressure (ICP) caused by venous hypertension. No cerebral alteration was seen on magnetic resonance imaging. To decrease the high ICP, surgical sinus isolation of the superior sagittal sinus was performed. After the surgery, transvenous embolization was performed to the right transverse-sigmoid sinus DAVF. Headache and tinnitus improved after these treatments, but visual activities rapidly declined and he experienced blindness in just a few months. Gamma knife radiosurgery was performed to the residual DAVFs. We discussed the etiology and treatment of the multiple DAVF, and reviewed past literatures.
authors.affiliation: Department of Neurosurgery, Shimane Central Prefectural Hospital.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Mitsuhara
authors.forename: Fusao
authors.initials: F
authors.lastname: Ikawa
authors.forename: Naohiko
authors.initials: N
authors.lastname: Ohbayashi
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Shirozu
authors.forename: Masaru
authors.initials: M
authors.lastname: Abiko
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Ichinose
mesh_terms: D000368:Aged; D001766:Blindness / Q000209:etiology; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D006801:Humans; D008297:Male; D016634:Radiosurgery; D054063:Superior Sagittal Sinus / Q000601:surgery