title: Issues in the diagnosis and management of the papilledema shunt.
abstract: BACKGROUND
  Dural arteriovenous fistulas (DAVFs) that shunt blood into the transverse or superior sagittal venous sinuses cause papilledema by raising intracranial pressure ("the papilledema shunt"). Such fistulas pose unique diagnostic and therapeutic challenges.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  In a patient presenting with papilledema, non-invasive brain vascular imaging disclosed subtle signs of a DAVF. Digital angiography delineated the DAVF and revealed cortical venous reflux. After three transarterial embolizations with ethylene vinyl alcohol, the DAVF was closed and papilledema resolved.
  
  
  CONCLUSIONS
  The imaging features of a DAVF that cause papilledema may be subtle on non-invasive vascular imaging. If overlooked, and lumbar puncture is performed, there is a substantial risk of brain herniation. Cortical venous reflux, which may be relatively common in these DAVFs, impels the need for endovascular closure. The transvenous route, often employed for closing cavernous sinus DAVFs, should be avoided because of the dangers of dural venous sinus thrombosis.
authors.affiliation: Departments of Radiology (Neurointerventional Radiology) (NC, JG, JJG, ASP), Neurosurgery (NC, JJG, ASP), Ophthalmology (JDT), and Neurology (JDT), University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chaudhary
authors.forename: Julius
authors.initials: J
authors.lastname: Griauzde
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Trobe
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D017023:Coronary Angiography; D019468:Disease Management; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010211:Papilledema / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000652:urine*; D015898:Tomography Scanners, X-Ray Computed; D014711:Vertebral Artery / Q000473:pathology