Presentation
New born with cardiac murmur and anterior fontanelle bruit.
Patient Data
Highly vascular cystic structure is seen in the posterior fossa, retrocerebellar, with multiple collateral vascularity seen around.
In the posterior fossa, there are tangles of blood vessels seen close to the tentorium cerebelli at the midline with secondary enlargement of the torcular herophili as well as both transverse sinuses and the distal part of the posterior sagittal sinus. The vein of Galen and straight sinus are not dilated. There is dilated meningeal arteries from external carotid and vertebral arteries bilaterally extending to the site of the dilated vessels in the posterior fossa. Findings are impressive of dural AV fistula
Case Discussion
Dural arteriovenous fistulas are pathologic dural-based fistulas representing about for 10%–15% of all cerebral vascular malformations. These fistulas derive the arterial supply from the meningeal arteries, and their venous drainage is through the dural venous sinuses or the cortical veins.
CT and MR imaging are main tools of the diagnosis, but conventional angiography is the most accurate method for complete diagnosis and classification of DAVFs.