Dural arteriovenous fistula

Case contributed by Dr Ian Bickle

Presentation

Right sensioneural hearing loss and facial palsy. No history of trauma or surgery.

Patient Data

Age: 45
Gender: Male

Initial Study was MRI-IAMS - proceeded to MRI Brain following initial review

Modality: MRI

Numerous tortous aberrant veins at the root entry zones of both IAMS, more pronounced on the right.  On the right these are impinging on the facial and vestibulocochlear nerves.

The dilated veins are a consequence of bilateral dural AV fistulas between the branches of the external carotid artery and sigmoid/tranverse sinuses.

The fistulous communication is largest on the right with distal external carotid artery branches feeding into the sigmoid-tranverse sinus junction. The right transverse sinus is markedly dilated measuring 1.1cm, as are the superficial cerebral veins of both cerebral hemispheres.

Dilated tranossesous and meningeal arteries are also communicating with the venous sinuses at the base of skull.

Extensive periventricular high T2 signal.

Dilated anterior spinal vessel.

Catheter Cerebral Angiogram images not available - however report as follows.

Selective cannulation of right and left carotid and right and left vertebral arteries.

This study shows multiple dural fistulae. There is fistula at the right transverse sinus with feeders from, right occipital and meningeal branches of right external carotid, dural branches of right posterior cerebral via right P-com and meningeal branches of the right vertebral artery.

On the left side there is a fistula at the lateral end of the left transverse sinus with dural branches of the left ICA, left occipital and middle meningeal from the left ECA. There is fistula at the torcula with branches from the dural branches of left vertebral and small branches from right posterior cerebral artery.

Carotids in the cervical, petrous, cavernous, paraclinoid and supraclinoid segments are with in normal limits.

Flow reversal in the sinuses in keeping with venous hypertension.

Comment: Multiple dural fistulae

Modality: Annotated image

The point of the right dural AVF is indicated ( inside red circle ) between external carotid artery branches and the sigmoid/traverse sinus confluence

Case Discussion

This is a phenomenal case of:

1. Bilateral dural AV fistulas

2. Cerebral venous hypertension secondary to dural AVFs

3. Right neurovascular conflict of the facial/vestibulocochlear nerve secondary to aberrant vessels from dural AVF.

An embolisation procedure has been performed althought it remains to be seen of the long term outcome given the magnitude of the findings.

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Case Information

rID: 31702
Case created: 22nd Oct 2014
Last edited: 8th Feb 2016
Inclusion in quiz mode: Included

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