Neurological Surgery No Shinkei Geka Volume 25, Issue 7 (July 1997)

Dural arteriovenous fistula involving the superior sagittal and transverse-sigmoid sinuses, treated by thrombolysis:case report Toshinari ARAI 1 , Kikuro OHNO 1 , Yoshikazu YOSHINO 1 , Youji TANAKA 1 , Tadashi NARIAI 1 , Kimiyoshi HIRAKAWA 1 , Shigeru NEMOTO 2 1Department of Neurosurgery, Tokyo Medical and Dental University 2Department of Neurosurgery, Tokyo Police Hospital Keyword: dural arteriovenous malformation , superior sagittal sinus , transverse sinus , jugular canal , thrombolysis pp.621-626
Published Date 1997/7/10
  • Abstract
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A rare case of dural arteriovenous fistula (DAVF) in the superior sagittal sinus (SSS), the transverse sinus and the sigmoid sinus is reported.

A 64-year-old man, who had had an episode of tem-porary visual disturbance after moderate fever for a week about 20 years before, was aware of loss of visual acuity and reduced field of view in the right eye. When he was introduced to our outpatient service, increased intracranial pressure (ICP) was detected by lumbar puncture. Cerebral angiograms showed bilateral DAVFs both in the posterior fossa and the SSS con-comitant with thrombosis in the transverse sinus, sig-moid sinus and SSS. Afterwards, endovascular trans-arterial embolization through bilateral occipital, pos-terior auricular and left middle meningeal, superior tem-poral arteries was carried out. In addition, transvenous thrombolytic therapy using a catheter inserted into SSS resulted in the improvement of his visual problems. Although he was discharged at once, he was readmit-ted to our department with Foster Kennedy syndrome and increased ICP. Cerebral angiograms showed recur-rence of both DAVF and sinus thrombosis. Transarterial embolization was performed again resulting in a signifi-cant reduction of DAVF, and his visual acuity was rec-overed to a moderate degree.

The origin of DAVF is still controversial. Although two theories, “congenital” and “acquired”, are put for-ward, it has been thought that both factors play impor-tant roles. In our case, the patient had stenosis in the jugular canal portions of the sigmoid sinus. In addition, sinus thrombosis seemed to have occurred. It is thought that increased intrasinus pressure may have lead to communication with surrounding arteries through ex-isting dural vessels.

We applied transvenous thrombolytic therapy in this case. Our result suggests that we should consider this therapy for some cases of DAVF.

Copyright © 1997, Igaku-Shoin Ltd. All rights reserved.


Neurological Surgery 脳神経外科
25巻7号 (1997年7月)
電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院