A case of multiple dural arteriovenous fistulas treated by multiple modalities

The authors report a rare case of multiple intracranial dural arteriovenous fistulas (DAVF) at separate sinuses. A 70-year-old man was introduced to our hospital complaining of visual disturbance due to bilateral choked disk, headache, and tinnitus. Initial angiography showed DAVFs involving the sup...

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Bibliographic Details
Published inNō shinkei geka Vol. 39; no. 6; p. 575
Main Authors Mitsuhara, Takafumi, Ikawa, Fusao, Ohbayashi, Naohiko, Shirozu, Hirofumi, Abiko, Masaru, Ichinose, Nobuhiko
Format Journal Article
LanguageJapanese
Published Japan 01.06.2011
Subjects
Aged
Blindness - etiology
Central Nervous System Vascular Malformations - complications
Central Nervous System Vascular Malformations - therapy
Cerebral Angiography
Embolization, Therapeutic
Humans
Male
Radiosurgery
Superior Sagittal Sinus - surgery
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Summary:The authors report a rare case of multiple intracranial dural arteriovenous fistulas (DAVF) at separate sinuses. A 70-year-old man was introduced to our hospital complaining of visual disturbance due to bilateral choked disk, headache, and tinnitus. Initial angiography showed DAVFs involving the superior sagittal sinus and bilateral transverse-sigmoid sinuses, and the occlusion of the right jugular vein. The patient developed progressive impairment of visual activity and had high intracranial pressure (ICP) caused by venous hypertension. No cerebral alteration was seen on magnetic resonance imaging. To decrease the high ICP, surgical sinus isolation of the superior sagittal sinus was performed. After the surgery, transvenous embolization was performed to the right transverse-sigmoid sinus DAVF. Headache and tinnitus improved after these treatments, but visual activities rapidly declined and he experienced blindness in just a few months. Gamma knife radiosurgery was performed to the residual DAVFs. We discussed the etiology and treatment of the multiple DAVF, and reviewed past literatures.
ISSN:0301-2603