title: Multiple Dural and Pial Arteriovenous Fistulae in a Twenty-Four-Year-Old Woman in the Setting of Superior Sagittal Sinus Thrombosis: Case Report and Review of Literature.
abstract: METHODS
  A 24-year-old woman presented with headache, nausea, and vomiting, and was found to have chronic superior sagittal sinus (SSS) thrombosis and multiple dural arteriovenous fistulae (dAVFs). Despite anticoagulant therapy and successful recanalization of her sinus, her fistulae persisted, and she developed additional separate pial arteriovenous fistulae (pAVFs). Her fistulae were treated with staged endovascular embolization, open clipping, and gamma knife radiosurgery over the course of 10 months. Complete resolution of SSS thrombosis and all arteriovenous fistulae (AVFs) was noted on cerebral angiogram performed 18 months from initial presentation.
  
  
  CONCLUSIONS
  dAVFs have frequently been associated with venous sinus thrombosis. Sinus thrombosis resulting after endovascular or surgical treatment of dural arteriovenous fistulous connections has been reported in literature and is considered a possible complication of treatment. Multiple dAVFs and pAVFs are rare and often require multimodal staged approaches for definitive treatment.
  
  
  CONCLUSIONS
  We report a case of chronic sagittal sinus thrombosis resulting in multiple AVFs requiring staged multimodal treatment with successful resolution of the fistulous connections. Furthermore, upon reviewing the literature addressing multiple dAVFs and the treatment of such lesions using endovascular, microsurgical, and stereotactic radiosurgery techniques, we elucidate the success a multimodal approach to therapy can afford for the unique challenges associated with multiple lesions.
authors.affiliation: Department of Neurological Surgery, University of Kentucky, Lexington, KY.
authors.forename: Farhan A
authors.initials: FA
authors.lastname: Mirza
authors.affiliation: Department of Neurological Surgery, University of Kentucky, Lexington, KY; Department of Radiology, University of Kentucky, Lexington, KY; Department of Neurology, University of Kentucky, Lexington, KY; Department of Anatomy and Neurobiology, University of Kentucky, Lexington, KY. Electronic address: jfr235@uky.edu.
authors.forename: Justin F
authors.initials: JF
authors.lastname: Fraser
mesh_terms: D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D002533:Cerebral Angiography / Q000379:methods; D002648:Child; D002675:Child, Preschool; D000072226:Computed Tomography Angiography; D003399:Craniotomy; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010841:Pia Mater / Q000098:blood supply*; D016634:Radiosurgery; D020225:Sagittal Sinus Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D054063:Superior Sagittal Sinus / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D055815:Young Adult
keywords: Dural arteriovenous fistula; embolization; pial arteriovenous fistula; radiosurgery; sagittal sinus thrombosis