title: Cavernous Sinus Dural Arteriovenous Fistula Presenting with Intracerebral Hemorrhage Associated with Chronological Angiographic Demonstration of Disturbed Leptomeningeal Venous Drainage as the Sole Outflow Route.
abstract: BACKGROUND
  Cavernous sinus (CS) dural arteriovenous fistula (DAVF) rarely causes intracranial hemorrhage. The authors describe a case of CS DAVF presenting with intracranial hemorrhage, focusing on the findings in digital subtraction angiography (DSA) performed before and after the onset.
  
  
  METHODS
  An 80-year-old woman, diagnosed as Borden type 3 CS DAVF on DSA 2 years before, presented with subarachnoid hemorrhage and right temporal subcortical hemorrhage. DSA findings after the onset showed that the right superficial middle cerebral vein, the sole drainage of the DAVF, had various changes including stenosis on the proximal portion, venous pouch formation, and occlusion of the distal portion compared with those 2 years before the onset. The occlusion was observed near the point where drainage of DAVF joined normal brain venous drainage, suggesting that the competition between the drainages caused impaired venous drainage, stagnation, and subsequent thrombotic occlusion. The CS DAVF was treated with evacuation of the intracerebral hematoma and surgical interruption of the right superficial middle cerebral vein at the dural origin from the CS.
  
  
  CONCLUSIONS
  This report showed the development of thrombotic occlusion of a distal draining cortical vein as one of risk factors for CS DAVFs to cause intracranial hemorrhage on repeated DSAs.
authors: Department of Neurosurgery, Matsusaka Central General Hospital, Matsusaka, Japan. Electronic address: satoru-tanioka@umin.net.
authors: Satoru
authors: S
authors: Tanioka
authors: Department of Neurosurgery, Matsusaka Central General Hospital, Matsusaka, Japan.
authors: Yu
authors: Y
authors: Sato
authors: Department of Neurosurgery, Matsusaka Central General Hospital, Matsusaka, Japan.
authors: Mai
authors: M
authors: Nampei
authors: Department of Neurosurgery, Matsusaka Central General Hospital, Matsusaka, Japan.
authors: Kazuhiko
authors: K
authors: Tsuda
authors: Department of Neurosurgery, Matsusaka Central General Hospital, Matsusaka, Japan.
authors: Shigehiko
authors: S
authors: Niwa
authors: Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors: Hidenori
authors: H
authors: Suzuki
mesh_terms: D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D002426:Cavernous Sinus / Q000000981:diagnostic imaging* / Q000601:surgery; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D002550:Cerebral Veins / Q000000981:diagnostic imaging* / Q000601:surgery; D003251:Constriction, Pathologic; D018450:Disease Progression; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D019635:Neurosurgical Procedures / Q000379:methods; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Borden type 3; Cavernous sinus dural arteriovenous fistula; Leptomeningeal venous drainage; Stenosis; Thrombosis; Venous pouch