[Intraventricular hemorrhage after dural fistula embolization].
OBJECTIVE
Dural arteriovenous fistulas are anomalous shunts between dural arterial and venous channels whose nidus is located between the dural leaflets. For those circumstances when invasive treatment is mandatory, endovascular techniques have grown to become the mainstay of practice, choice attributable to their reported safety and effectiveness. We describe the unique and rare case of a dural arteriovenous fistula treated by transarterial embolization and complicated by an intraventricular hemorrhage. We aim to emphasize some central aspects of the perioperative management of these patients in order to help improving the future approach of similar cases.


METHODS
A 59-year-old woman with a previously diagnosed Cognard Type IV dural arteriovenous fistula presented for transarterial embolization, performed outside the operating room, under total intravenous anesthesia. The procedure underwent without complications and the intraoperative angiography revealed complete obliteration of the fistula. In the early postoperative period, the patient presented with clinical signs of raised intracranial pressure attributable to a later diagnosed intraventricular hemorrhage, which conditioned placement of a ventricular drain, admission to an intensive care unit, cerebral vasospasm and a prolonged hospital stay. Throughout the perioperative period, there were no changes in the cerebral brain oximetry. The patient was discharged without neurological sequelae.


CONCLUSIONS
Intraventricular hemorrhage may be a serious complication after the endovascular treatment of dural arteriovenous fistula. A close postoperative surveillance and monitoring allow an early diagnosis and treatment which increases the odds for an improved outcome.
Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Departamento de Anestesiologia, Matosinhos, Portugal.
Joana Chaves Gonçalves Rodrigues
JC
de Carvalho
Universidad de Barcelona, Hospital Clínic, Departamento de Anestesiología, Barcelona, Espanha.
Francisco Javier Tercero
FJ
Machin
Universidad de Barcelona, Hospital Clínic, Departamento de Neurorradiología Intervencionista (CDI), Barcelona, Espanha.
Luis San Roman
LS
Manzanera
Universidad de Barcelona, Hospital Clínic, Departamento de Neurorradiología Intervencionista (CDI), Barcelona, Espanha.
Jordi Blasco
JB
Andaluz
Universidad de Barcelona, Hospital Clínic, Sala de Recuperación Postanestésica, Barcelona, Espanha.
Sílvia Herrero
SH
Nogués
Universidad de Barcelona, Hospital Clínic, Sala de Recuperación Postanestésica, Barcelona, Espanha.
Núria Peix
NP
Soriano
Universidad de Barcelona, Hospital Clínic, Departamento de Neurología, Barcelona, Espanha.
Victor Obach
VO
Baurier
Universidad de Barcelona, Hospital Clínic, Departamento de Anestesiología, Barcelona, Espanha. Electronic address: ecarrero@clinic.ub.es.
Enrique Jesus
EJ
Carrero Cardenal
D020785:Central Nervous System Vascular Malformations / Q000628:therapy*; D000074042:Cerebral Intraventricular Hemorrhage / Q000209:etiology*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged
Arteriovenous malformation; Cerebral oximetry; Cerebral perfusion; Dural fistula; Fístula dural; Hemorragia intraventricular; Intraventricular hemorrhage; Malformação arteriovenosa; Oximetria cerebral; Perfusão cerebral