title: Complex dural arteriovenous fistula in Bannayan-Riley-Ruvalcaba syndrome.
abstract: In this paper the authors report the case of a complex dural arteriovenous fistula (dAVF) with high-risk features in a 14-year-old girl with Bannayan-Riley-Ruvalcaba syndrome (BRRS), a phosphatase and tensin homolog-associated syndrome, presenting with signs and symptoms of increased intracranial pressure (ICP) that had previously been attributed to pseudotumor cerebri. This fistula was obliterated following 2 stages of embolization, and the patient experienced immediate symptomatic improvement. At the 2-month follow-up evaluation, the fistula remained angiographically occluded, and her symptoms continue to improve. This is the third reported case of an intracranial dAVF in a patient with BRRS. Because high-risk dAVFs can result in devastating morbidity, early detection with vascular imaging is crucial for patients with BRRS presenting with signs of increased ICP. Goals of treatment should include complete fistula obliteration whenever possible.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
authors.forename: Karam
authors.initials: K
authors.lastname: Moon
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Ducruet
authors.forename: R Webster
authors.initials: RW
authors.lastname: Crowley
authors.forename: Kathleen
authors.initials: K
authors.lastname: Klas
authors.forename: Ruth
authors.initials: R
authors.lastname: Bristol
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
mesh_terms: D000293:Adolescent; D000792:Angiography; D015901:Angiography, Digital Subtraction; D021721:Balloon Occlusion; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods; D002658:Developmental Disabilities / Q000209:etiology; D003937:Diagnosis, Differential; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005820:Genetic Testing; D006223:Hamartoma Syndrome, Multiple / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D058627:Megalencephaly / Q000150:complications; D009154:Mutation; D051059:PTEN Phosphohydrolase / Q000235:genetics*; D011145:Polyvinyls / Q000008:administration & dosage; D013635:Tantalum / Q000008:administration & dosage
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum; D051059:PTEN Phosphohydrolase; C494929:PTEN protein, human