title: [Childhood transverse sinus dural arteriovenous fistula treated with endovascular and direct surgery: a case report].
abstract: Infantile dural arteriovenous fistula is a rare cerebrovascular malformation carrying a poor prognosis with an anatomic cure of only 9%. Endovascular embolization is mainly selected to treat this entity, aiming to obtain normal development of the patients.  We present a case of a 20-month-old girl with epilepsy. Digital subtraction angiography revealed a dural arteriovenous fistula involving the right transverse sinus. The arteriovenous fistula was fed by multiple dural branches from the middle meningeal, occipital, meningohypophyseal, and anteroinferior cerebellar arteries. The right transverse sinus was transvenously embolized with platinum coils. Although the shunt flow remained, the patient was liberated from epilepsy. Nine months later, the patient suffered from a recurrence of epilepsy. Digital subtraction angiography demonstrated some increase in shunt flow. Right middle meningeal, occipital, posterior deep temporal, and tentorial arteries were transarterially embolized using N-butyl cyanoacrylate, followed by complete surgical resection of the right transverse sinus. The shunt flow disappeared after surgery, and her epilepsy improved significantly. Our experience suggests that the combination of endovascular and surgical treatment is effective for recurrent infantile dural arteriovenous fistula.
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai-City, Miyagi, Japan.
authors.forename: Kuniyasu
authors.initials: K
authors.lastname: Niizuma
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sakata
authors.forename: Shinya
authors.initials: S
authors.lastname: Koyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kon
authors.forename: Masashi
authors.initials: M
authors.lastname: Chonan
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Sasaki
authors.forename: Michiharu
authors.initials: M
authors.lastname: Nishijima
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ezura
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007223:Infant; D054064:Transverse Sinuses / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures