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      A falcotentorial dural arteriovenous fistula presented as carotid cavernous fistula clinically treated by transarterial embolization: case report

      case-report

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          Abstract

          Background

          Dural arteriovenous fistulas (DAVF) represent almost 10–15% of intracranial malformations that cause intracranial hemorrhage and focal neurological deficits. Seldom tentorial DAVF cases present with ocular manifestations initially, which occur frequently in carotid–cavernous fistula (CCF) and cavernous sinus DAVF (CS DAVF).

          Case presentation

          We report an unusual falcotentorial DAVF case draining via the superior and inferior ophthalmic veins that caused left-side increased intraocular pressure. The patient’s chief complaint was swelling on the left side, pain and conjunctival congestion. He received endovascular embolization via a transarterial approach, and postoperative angiography demonstrated that the falcotentorial DAVF was occluded completely.

          Conclusion

          Except for CCF and CS DAVF, some specific subtypes of DAVF should be considered if the patient initially presents with ocular symptoms. Differential diagnosis and definitive treatment are mandatory to avoid a delayed diagnosis and irreversible symptoms.

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          Most cited references13

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          Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage.

          Y. Pierre Gobin, J Merland, J Chiras … (1995)
          To review the symptoms and progression of dural arteriovenous fistulas (AVFs) and correlate the findings with various angiographic patterns. Patterns of venous drainage allowed classification of dural AVFs into five types: type I, located in the main sinus, with antegrade flow; type II, in the main sinus, with reflux into the sinus (IIa), cortical veins (IIb), or both (IIa + b); type III, with direct cortical venous drainage without venous ectasia; type IV, with direct cortical venous drainage with venous ectasia; and type V, with spinal venous drainage. Type I dural AVFs had a benign course. In type II, reflux into the sinus induced intracranial hypertension in 20% of cases, and reflux into cortical veins induced hemorrhage in 10%. Hemorrhage was present in 40% of cases of type III dural AVFs and 65% of type IV. Type V produced progressive myelopathy in 50% of cases. This classification provides useful data for determination of the risk with each dural AVF and enables decision-making about the appropriate therapy.
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            Tentorial dural arteriovenous fistulae: operative strategies and microsurgical results for six types.

            Michael Lawton, Rene Sanchez-Mejia, Diep Vu-Pham … (2008)
            Tentorial dural arteriovenous fistulae (DAVF) are rare, have a high risk of hemorrhage, often cannot be obliterated endovascularly, and frequently require microsurgical interruption of the draining vein. We differentiated these fistulae into six types and developed specific operative strategies on the basis of these types.
            Article 0 comments Cited 34 times – based on 0 reviews     Review now
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              Etiological evaluation of dural arteriovenous malformations of the lateral and sigmoid sinuses based on histopathological examinations.

              M Nishijima, N Kuwayama, F Koizumi … (1992)
              Controversy persists concerning the pathogenesis of dural arteriovenous malformations (AVM's) and whether they are congenital or acquired. Furthermore, it remains undetermined whether the lesion is located in the sinus itself or within the sinus wall. In order to elucidate the pathogenesis of dural AVM's of the lateral and sigmoid sinuses, histopathological profiles of this disease were studied in serial sections of completely resected lesions from three patients. The essential lesion was histologically confirmed to be a dural arteriovenous fistula within the wall of the venous sinuses. The etiology process of this disease and its progression were evaluated.
              Article 0 comments Cited 15 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Yuan Shi: yuanshi18@fudan.edu.cn
                Peixi Liu: liupeixi@dufan.edu.cn
                Yingtao Liu: 964525045@qq.com
                Kai Quan: abcmo@163.com
                Yanlong Tian: yanlongtian@126.com
                Wei Zhu: drzhuwei@fudan.edu.cn
                Journal
                Journal ID (nlm-ta): Chin Neurosurg J
                Journal ID (iso-abbrev): Chin Neurosurg J
                Title: Chinese Neurosurgical Journal
                Publisher: BioMed Central (London )
                ISSN (Print): 2095-9370
                ISSN (Electronic): 2057-4967
                Publication date (Electronic): 14 December 2022
                Publication date PMC-release: 14 December 2022
                Publication date Collection: 2022
                Volume: 8
                Electronic Location Identifier: 41
                Affiliations
                [1 ]GRID grid.8547.e, ISNI 0000 0001 0125 2443, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, , Fudan University, ; Shanghai, China
                [2 ]National Center for Neurological Disorders, Shanghai, China
                [3 ]GRID grid.22069.3f, ISNI 0000 0004 0369 6365, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, ; Shanghai, China
                [4 ]GRID grid.8547.e, ISNI 0000 0001 0125 2443, Neurosurgical Institute of Fudan University, ; Shanghai, China
                [5 ]GRID grid.411405.5, ISNI 0000 0004 1757 8861, Shanghai Clinical Medical Center of Neurosurgery, ; Shanghai, China
                [6 ]GRID grid.8547.e, ISNI 0000 0001 0125 2443, Department of Radiology, Huashan Hospital, Shanghai Medical College, , Fudan University, ; Shanghai, China
                Article
                Publisher ID: 309
                DOI: 10.1186/s41016-022-00309-w
                PMC ID: 9749196
                PubMed ID: 36517912
                SO-VID: b72617a1-4358-4ea9-96e3-990e8ede3d24
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 28 September 2022
                Date accepted : 20 November 2022
                Funding
                Funded by: The Outstanding Academic Leaders Program of Shanghai Municipal Commission of Health and Family Planning
                Award ID: 21XD1400600
                Award Recipient :
                Funded by: National Natural Science Foundation of Chin
                Award ID: 82171311
                Award Recipient :
                Funded by: Outstanding Academic Leaders Program of Shanghai Municipal Commission of Health and Family Planning
                Award ID: 2017BR006
                Award Recipient :
                Funded by: Clinical Research Plan of SHDC
                Award ID: SHDC2020CR2034B
                Award ID: SHDC2020CR4033
                Award Recipient :
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                Keywords: dural arteriovenous fistulas,falcotentorial davf,ocular symptoms,case report
                Data availability:
                Keywords: dural arteriovenous fistulas, falcotentorial davf, ocular symptoms, case report

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