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Posterior Fossa Dural Arteriovenous Fistula with Isolated Sinus Segment Ichiro Nakahara 1,4 , John Pile-Spellman 1 , Lotfi Hacein-Bey 1 , Robert M Crowell 2 , Daryl Gress 3 1Department of Radiology, Massachusetts General Hospital, Harvard University 2Department of Neurosurgery, Massachusetts General Hospital, Harvard University 3Department of Neurology, Massachusetts General Hospital, Harvard University Keyword: dural arteriovenous fistulas , posterior cranial fossa , isolated sinus segment , transarterial embolization , n-butyl cyanoacrylate pp.703-709
Published Date 1993/8/1
DOI https://doi.org/10.11477/mf.1406900515
  • Abstract
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Radiological and clinical analysis was performed in 5 patients with posterior fossa dural arterio-venous fistulas (DAVFs) with isolated sinus seg-ment due to sinus thrombosis, and their patho physiological, diagnostic, and therapeutic concerns were discussed. Patients ranged in age from 36 to 73 years old with a mean of 57 years and included 2 males and 3 females. Two patients presented with ataxia, one with ataxia and bruit, one with atypical facial pain, and one with parietal dysfunction. One patient had a history of hemorrhagic event. DAVFs were located at transverse-sigmoid sinus (3 cases), superior petrosal sinus (1 case), and straight sinus (1 case). They were fed by many branches of ex-ternal carotid artery including middle meningeal artery, ascending pharyngeal artery, posterior auri-cular artery, occipital artery, meningeal branches of vertebral artery and posterior cerebral artery, and meningohypophyseal trunk of internal carotid artery. Shunt flow drained into contralateral trans-verse - sigmoid or supratentorial sinuses via the isolated venous segment through markedly dilated cortical and/or deep venous systems, which caused altered normal venous drainage pattern and venous hypertension. Transarterial embolization in multi-ple stages (mean 3.4) using n-butyl cyanoacrylate (NBCA) could alleviate symptoms in all cases. DAVFs were almost totally obliterated in 3 patients. Further embolization in one case, and surgical excision in one case were planed because of some residual dilated cortical venous drainage.

Posterior fossa DAVFs with isolated sinus seg-ment accompany markedly dilated cortical and/or deep venous systems. They could cause cerebellar, brainstem, or cranial nerve dysfunctions, and some-times present distant supratentorial symptoms or hydrocephalus due to abnormal venous drainage and venous hypertension. Also, high risk of intra-cranial hemorrhage justifies the invasive treatment. Staged transarterial embolization using NBCA appeared extremely useful in managing these DAVFs with gradual decrease of venous hyperten-sion without recanalization of the occluded vessel.


Copyright © 1993, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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