title: Intraventricular hemorrhage after dural fistula embolization.
abstract: 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.
authors.affiliation: Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Departamento de Anestesiologia, Matosinhos, Portugal.
authors.forename: Joana Chaves Gonçalves Rodrigues
authors.initials: JC
authors.lastname: de Carvalho
authors.affiliation: Universidad de Barcelona, Hospital Clínic, Departamento de Anestesiología, Barcelona, Spain.
authors.forename: Francisco Javier Tercero
authors.initials: FJ
authors.lastname: Machin
authors.affiliation: Universidad de Barcelona, Hospital Clínic, Departamento de Neurorradiología Intervencionista (CDI), Barcelona, Spain.
authors.forename: Luis San Roman
authors.initials: LS
authors.lastname: Manzanera
authors.affiliation: Universidad de Barcelona, Hospital Clínic, Departamento de Neurorradiología Intervencionista (CDI), Barcelona, Spain.
authors.forename: Jordi Blasco
authors.initials: JB
authors.lastname: Andaluz
authors.affiliation: Universidad de Barcelona, Hospital Clínic, Sala de Recuperación Postanestésica, Barcelona, Spain.
authors.forename: Sílvia Herrero
authors.initials: SH
authors.lastname: Nogués
authors.affiliation: Universidad de Barcelona, Hospital Clínic, Sala de Recuperación Postanestésica, Barcelona, Spain.
authors.forename: Núria Peix
authors.initials: NP
authors.lastname: Soriano
authors.affiliation: Universidad de Barcelona, Hospital Clínic, Departamento de Neurología, Barcelona, Spain.
authors.forename: Victor Obach
authors.initials: VO
authors.lastname: Baurier
authors.affiliation: Universidad de Barcelona, Hospital Clínic, Departamento de Anestesiología, Barcelona, Spain. Electronic address: ecarrero@clinic.ub.es.
authors.forename: Enrique Jesus
authors.initials: EJ
authors.lastname: Carrero Cardenal
mesh_terms: D000771:Anesthesia, Intravenous; D000792:Angiography / Q000379:methods; D020785:Central Nervous System Vascular Malformations / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D010092:Oximetry / Q000379:methods
keywords: Arteriovenous malformation; Cerebral oximetry; Cerebral perfusion; Dural fistula; Fístula dural; Hemorragia intraventricular; Intraventricular hemorrhage; Malformação arteriovenosa; Oximetria cerebral; Perfusão cerebral