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Background: Hypoglossal canal dural arteriovenous fistulas (HCDAVFs) are a relatively rare subtype of dural arteriovenous fistula (dAVF), representing 3%-5% of all dAVFs. The complex angio- and venous architecture predisposed to numerous anastomoses and nearby anatomical structures, including the posterior fossa sinuses and cranial nerves, can complicate both the diagnosis and treatment of these lesions., Observations: The authors describe the case of HCDAVF in a 74-year-old male who presented with pulsatile tinnitus (PT) lasting 3 months and significant fatigue, headaches, and dizziness. Diagnostic cerebral angiography demonstrated a left-sided HCDAVF with bilateral supply from the ascending pharyngeal arteries and fistulous connection at the level of the left anterior condylar vein (ACV). This lesion was consistent with a Cognard and Borden type I dAVF., Lessons: The authors present a case in which transvenous embolization (TVE) with detachable coils via the ipsilateral internal jugular vein successfully occluded the previously visualized shunt to the left ACV and provided a clinical cure for the patient's PT and headaches without complication. Selecting the appropriate treatment strategy for the successful treatment of HCDAVFs is predicated on a comprehensive understanding of the anatomical features of the lesion, namely arterial feeders, venous drainage pattern, and location of the fistulous connection. TVE is a safe and efficacious treatment option for HCDAVFs. https://thejns.org/doi/10.3171/CASE24606.

This case series aimed to review the significance of revisiting papilledema after successful cerebral venous sinus thrombosis (CVST) management with sinus angioplasty. Four patients presented with blurring and transient obscuration of vision with papilledema, headache, tinnitus, and vomiting. On magnetic resonance venography and digital subtraction angiography, chronic transverse sinus thrombosis was diagnosed for which patients underwent endovascular intervention (stenting). After the resolution of CVST, patients developed the recurrence of symptoms which on digital subtraction angiography revealed dural arteriovenous malformation (DAVM). DAVM and papilledema resolved with endovascular embolization. This case series highlights a need of constant monitoring of CVST cases after the endovascular intervention.

Effective management of complex vascular malformation remains one of the more challenging problems faced in most of the developing countries where modern therapeutic resources are deficient. Giant arteriovenous malformations and other vascular malformation like dural arteriovenous malformations are often associated with higher morbidity and mortality rates. These lesions are considered as untreatable or inoperable. Endovascular therapy is an expanding science for managing complex vascular malformations in Nepal that has many constraints. This outset will have positive impact in the country that has to deal with moderate resources to provide wide therapeutic benefit. Here we present our preliminary experience about the use of ethylene vinyl alcohol (Onyx- 18) to embolize dural arteriovenous fistula and use of n-butyl cyanoacrylate to embolize giant supratentorial arteriovenous malformation.

This case series aimed to review the significance of revisiting papilledema after successful cerebral venous sinus thrombosis (CVST) management with sinus angioplasty. Four patients presented with blurring and transient obscuration of vision with papilledema, headache, tinnitus, and vomiting. On magnetic resonance venography and digital subtraction angiography, chronic transverse sinus thrombosis was diagnosed for which patients underwent endovascular intervention (stenting). After the resolution of CVST, patients developed the recurrence of symptoms which on digital subtraction angiography revealed dural arteriovenous malformation (DAVM). DAVM and papilledema resolved with endovascular embolization. This case series highlights a need of constant monitoring of CVST cases after the endovascular intervention. [ABSTRACT FROM AUTHOR]

Endovascular management of dural arteriovenous fistulas has become a mainstay of treatment. In particular, modern techniques have allowed greater fistula penetration and likelihood of complete obliteration. However, the efficacy of newer agents has not been quantified outside of predominantly small case reports and case series. Furthermore, the Australian experience with fistula embolization has yet to be reported in the literature. To this aim, we performed a retrospective review of our endovascular management of a large cohort of cranial dural arteriovenous fistulas in the liquid embolic era. This retrospective case series included ninety-six consecutive patients of any Cognard grade, treated between 2005 and 2016. Liquid embolic agents were used exclusively in eighty-three cases. The overall complete obliteration rate was 89.6% with a residual fistula rate of 2%, and complication rate of 8.3%. This Sydney, Australia cohort demonstrates excellent treatment effect and safety outcomes and thus supports the primary treatment of this condition by endovascular means. [ABSTRACT FROM AUTHOR]

Dural arteriovenous fistulas (DAVFs) may have aggressive symptoms, especially if there is direct cortical venous drainage. We report our preliminary experience in transarterial embolization of DAVFs with direct cortical venous drainage (CVR) using Onyx®. METHOD: Nine patients with DAVFs with direct cortical venous drainage were treated: eight type IV and one type III (Cognard). Treatment consisted of transarterial embolization using Onyx-18®. Immediate post treatment angiographies, clinical outcome and late follow-up angiographies were studied. RESULTS: Complete occlusion of the fistula was achieved in all patients with only one procedure and injection in only one arterial pedicle. On follow-up, eight patients became free from symptoms, one improved and no one deteriorated. Late angiographies showed no evidence of recurrent DAVF. CONCLUSION: We recommend that transarterial Onyx® embolization of DAVFs with direct cortical venous drainage be considered as a treatment option, while it showed to be feasible, safe and effective.As fistulas arteriovenosas durais (FAVDs) podem se manifestar com sintomas agressivos, especialmente se existe drenagem cortical direta. Relatamos nossa experiência preliminar na embolização transarterial de FAVDs com drenagem cortical direta usando Onyx®. MÉTODO: Nove pacientes com FAVDs com drenagem cortical direta foram tratados: oito do tipo IV e uma do tipo III (Cognard). O tratamento consistiu na embolização transarterial usando Onyx-18®. Angiografias imediatas pós-tratamento, evolução clínica e angiografias de controle tardias foram estudadas. RESULTADOS: A oclusão completa da fístula foi alcançada em todos pacientes através de um só procedimento e injeção em apenas um pedículo arterial. No seguimento, oito pacientes ficaram livres de sintomas, um melhorou e nenhum deteriorou. Angiografias tardias de controle não mostraram evidência de FAVD recorrente. CONCLUSÃO: Nós recomendamos que a embolização transarterial com Onyx® das FAVDs com drenagem cortical direta, seja considerada como uma opção terapêutica, uma vez que mostrou ser factível, segura e efetiva.

Effective management of complex vascular malformation remains one of the more challenging problems faced in most of the developing countries where modern therapeutic resources are deficient. Giant arteriovenous malformations and other vascular malformation like dural arteriovenous malformations are often associated with higher morbidity and mortality rates. These lesions are considered as untreatable or inoperable. Endovascular therapy is an expanding science for managing complex vascular malformations in Nepal that has many constraints. This outset will have positive impact in the country that has to deal with moderate resources to provide wide therapeutic benefit. Here we present our preliminary experience about the use of ethylene vinyl alcohol (Onyx-18) to embolize dural arteriovenous fistula and use of n-butyl cyanoacrylate to embolize giant supratentorial arteriovenous malformation. [ABSTRACT FROM AUTHOR]

The material for this research consisted of 93 patients with dural arteriovenous malformations (DAVMs) who were studied retrospectively with regards to therapeutic success and failure, who had undergone either neurosurgery, or embolization or a combination of both methods and whose disease was located in the cavernous sinus, the superior sagittal sinus, the transverse-sigmoid sinus of the anterior fossa and the tentorium. Thus, it was possible to arrive at the following conclusions: treatment of the DAVMs must be indicated, jointly, by an interventionist neuroradiologist and a neurosurgeon; DAVMs of the transverse-sigmoid sinus were better treated when a combination of both methods was used; DAVMs of the tentorium were also better treated with a combined method; the endovascular method ensured only a 50% chance of therapeutic success for DAVMs of the superior sagittal sinus; DAVMs of the cavernous sinus are better treated when the endovascular method was used with a transvenous approach, relative to the transarterial approach.O material utilizado consistiu de 93 pacientes portadores de malformações arteriovenosas durais (MAVDs) estudados retrospectivamente em relação ao sucesso e ao fracasso terapêutico submetidos aos métodos neurocirúrgico ou endovascular ou, ainda, combinação entre ambos, em que a doença se localizou nas regiões do seio cavernoso, do seio sagital superior, do seio transverso-sigmóide, da fossa anterior e do tentório. As conclusões foram as seguintes: o tratamento das MAVDs deve ser indicado pelo neurorradiologista intervencionista e pelo neurocirurgião, conjuntamente; as MAVDs do seio transverso-sigmóide foram melhor tratadas através do método combinado; as MAVDs do tentório foram melhor tratadas através do método combinado; as MAVDs do seio sagital superior tratadas por método endovascular asseguraram apenas 50% de sucesso terapêutico; as MAVDs do seio cavernoso são melhor tratadas por método endovascular empregando-se a via transvenosa quando comparadas com a via transarterial.

We present a striking example of hypertrophic olivary degeneration after cerebellar hemorrhage. This case highlights some important teaching points: unique response of the inferior olivary nucleus to de-afferentation, anatomy of Mollaret’s triangle and clinical manifestations of disruption in Mollaret’s triangle. The purpose of this teaching case is to highlight a rare but important post-stroke complication. [ABSTRACT FROM AUTHOR]

Abstract: A 20-year-old Hispanic man with Down syndrome presented with progressively worsening headache, fluctuating decreased vision, and bilateral optic disk edema. Magnetic resonance imaging of the head showed an empty sella, and magnetic resonance venography showed thrombosis of left transverse and sigmoid sinuses. Catheter angiography angiogram showed a dural arteriovenous fistula in the wall of left transverse and sigmoid sinuses. The patient underwent Onyx endovascular embolization of the fistula, resulting in its angiographic obliteration, followed by resolution of his clinical signs and symptoms. [Copyright &y& Elsevier]

Introduction: Endovascular treatment of dural arteriovenous malformation is challenging especially if the related dural venous sinus is patent and might be usable for normal venous drainage. Methods: A new particular venous balloon remodeling technique was described in the treatment of transverse-sigmoid dural arteriovenous malformation by using transarterial Onyx. The goal was obliteration of the malformation with preservation of the dural sinus. Two illustrative cases with 6-month follow-up result were narrated. Results: The penetration of Onyx in the dural arterial feeders was well achieved. Obliteration of the malformation with preservation of the dural sinus was finally demonstrated. Conclusion: Transvenous balloon assistance is a useful and feasible technique in the treatment of dural arteriovenous malformation when sinus preservation is in concern. [ABSTRACT FROM AUTHOR]

Tentorial dural arteriovenous fistula (DAVF) is a rare vascular disease, which accounts for less than 4% of all cases of intracranial DAVF. Because of the high risk of intracranial hemorrhage, patients with tentorial DAVF need aggressive treatment. Management approaches are still controversial, and endovascular treatment has emerged as an effective alternative. In the current work, we describe our experience with the endovascular approach in the treatment of these deep and complex DAVF of the tentorium. Eight patients were treated between January 2006 and July 2009. Six patients (75%) presented with intracranial hemorrhage related to the DAVF rupture. Four patients (50%) had subarachnoid bleeding and two had intraparenchymal hematoma. Endovascular treatment was performed via the transarterial route alone in five cases (62.5%), by the transvenous approach in two cases (25.0%) and in a combined procedure using both arterial and venous routes in one patient (12.5%). Complete obliteration of the fistula was achieved in all cases. The outcome at 15 months was favorable (modified Rankin scale 0-3) in seven (87.5%) patients. Complete cure of the lesion was confirmed in these cases. This paper reports on the effectiveness of endovascular treatment in tentorial DAVF management. The choice of the venous versus the arterial approach is determined by regarding different anatomical dispositions. [ABSTRACT FROM AUTHOR]

Transvenous embolization has become the treatment of choice for such lesions We evaluated Onxy for patients with cavernous dural arteriovenous fistulae (CDAVFs) who underwent transvenous embolization via different transvenous approaches. Case records of six patients with symptomatic CDAVFs, treated between October 2006 and November 2007 were reviewed. A total of seven transvenous procedures were performed in the six patients with CDAVFs. All the patients with CDAVFs of the cavernous sinus were symptom free following embolization. The approach via the internal jugular vein and the inferior petrosal sinus was possible in four of the six patients, with complete occlusion of the fistula. In the remaining two patients, the approach was via the facial vein. Transient bradyarrythmia without morbidity was the only complication in two patients. [ABSTRACT FROM AUTHOR]

Tentorial dural arteriovenous fistulas are rare and complex lesions in deep locations with unusual vascular anatomy and critical surrounding neuroanatomy. A rare case presenting a complex fistula with a giant venous draining ampulae, causing headaches and visual troubles is presented. We describe the case of a 52-year-old woman admitted in our department for headaches and visual troubles. Magnetic resonance imaging and cerebral angiography showed a tentorial dural arteriovenous fistula draining in a giant tentorial venous ampulae and leptomeningeal veins. The patient was embolised via an arterial route with a good clinical and radiological result. However, 4 days later she presented a sudden change of her clinical status with coma, left hemiparesis and a right midriasis. The cerebral computed tomography scan showed a huge occipital haemorrhagic mass and a severe cerebral oedema. An emergent surgical procedure was decided realising evacuation of the occipital haematoma and a complete resection of the giant venous ampoule. The neck of the ampulae was sutured and clipped at its dural entrance. Postoperatively a new embolisation was realised because of persistent of a small dural fistulae with occipital leptomeningeal drainage. The patient recovered rapidly with only a residual hemianopsy. Treatment of dural AV malformation represent a serious challenge. Our report describes an unusual case of a tentorial dural complex fistula treated by an endovascular procedure with secondary clinical aggravation that needed emergent surgical therapy. Even in a case for good immediate radiological result after endovascular procedure, dural arteriovenous fistulas with giant venous ampulae and important venous engorgement, need closed follow-up, because of the possibility of aggravation secondary to venous thrombosis and haemorrhage. Treatment and patophysiology of the aggravation mechanism are discussed. [ABSTRACT FROM AUTHOR]

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An unusual case of dural arteriovenous malformation (DAVM) harboring a parallel transverse-sigmoid sinus (TSS) is presented. The patient had a 2-year history of left-sided pulsatile tinnitus in the left ear refractory to medical management. Angiography demonstrated a DAVM involving the left TSS. Super-selective transvenous dural sinus occlusion of the DAVM situated at the pathological compartment of the TSS provided cure. We were able to spare the normal compartment providing anatomical venous drainage from this system. [ABSTRACT FROM AUTHOR]

Dural arteriovenous malformations of the middle cranial fossa are very rare. Venous drainage flows either through superficial leptomeningeal veins or through the sphenoparietal, sphenopetrous and/or sphenobasilar sinuses. They often have an aggressive course and therefore poor outcome. It is essential to analyse and understand the angioarchitecture of the dural arteriovenous malformations in order to select and plan the correct treatments. We describe an exceptional case of intraventricular haemorrhage caused by the rupture of a dural arteriovenous malformation of the middle cranial fossa. To our knowledge, this is the first case report of such characteristics described in the literature. [ABSTRACT FROM AUTHOR]

This study evaluated angiographic and clinical results in patients with a dural arteriovenous fistula (DAVF) who underwent percutaneous transvenous embolization. Retrospective chart analysis and radiographic studies were performed in 23 patients (aged 11- 70 yrs) with a DAVF treated with percutaneous transvenous embolization in the past five years. Lesions were located in the anterior cranial fossa, cerebellar tentorium, transverse-sigmoid sinus and cavernous sinus. All procedures were analyzed with regard to presentation, delivery, angiographical and clinical outcome. Data for 23 patients (age range, 11-70 yrs, mean age 49.5yrs) with DAVFs (cavernous sinus[CS], n=17; transverse-sigmoid sinus, n=3; anterior cranial fossa, n=2; cerebellar tentorium, n=1) were retrospectively reviewed. The DAVFs were treated with coils or a combination with Onyx via different transvenous approaches, in 28 procedures. Cerebral angiography was performed to confirm the treatment. The mean clinical follow-up period was 22.1 months. Transvenous treatment of intracranial DAVFs can be safe and effective if various transvenous approaches are attempted. Percutaneous transvenous embolization with detachable platinum coils or a combination with Onyx is effective in the treatment of DAVFs. [ABSTRACT FROM AUTHOR]

We report on patients with cavernous dural arteriovenous fistulae (CDAVFs) who underwent transvenous embolization via different transvenous approaches with Onyx and coils. Twelve patients presenting with clinically symptomatic CDAVFs who were treated between August 2005 and November 2007 at Beijing Tiantan Hospital were reviewed. The approach routes, angiographic results and clinical outcome were assessed. Retrospective analysis of data for 12 patients (age range 36-75 yrs, mean age 59.3 yrs) with CDAVFs was performed. The CDAVFs were treated with Onyx and coils via different transvenous approaches in 14 procedures. Cerebral angiography was performed to confirm the treatment and diagnosis. The mean clinical follow-up period was 5.5 months. A total of 13 transvenous procedures and one transarterial procedure were performed for 12 CDAVFs. Eleven patients with CDAVFs of the CS were cured with respect to clinical symptoms, and one patient experienced improvement. The approach via the internal jugular vein and inferior petrosal sinus (n=10) was possible, with complete occlusion of the fistula in all cases. With the approach via the facial vein (n=2), there was a good success rate. We encountered no complications in any of the cases. Transvenous treatment of CDAVFs with Onyx and coils can be an effective option for different transvenous approaches. [ABSTRACT FROM AUTHOR]

Trigeminal neuralgia has been rarely reported in association with dural arteriovenous malformations (DAVMs). We describe a case of trigeminal neuralgia resulting from compression of the trigeminal nerve at its root entry zone by a large tentorial DAVM. Surgical interruption of the draining vein at its exit from the tentorium resulted in complete angiographic obliteration of the fistula with immediate resolution of the facial pain. We review the literature relevant to this topic and discuss the aetiology and pathophysiology of trigeminal neuralgia as well as the management of tentorial DAVMs. [ABSTRACT FROM AUTHOR]

A noninvasive treatment of an occipital dural AV fistula by external compression of the carotid artery and jugular vein is documented. The late successful occlusion of the malformation after almost 19 months and a total of 13,216 single manual compressions shows that fistula occlusion can be achieved late and is dependent on careful performance of the maneuver. [ABSTRACT FROM AUTHOR]

Abstract: Background: Tentorial dAVMs as a cause of trigeminal neuralgia are extremely rare. Consensus exists that radical treatment of such high-flow dAVMs should be considered because of their high risk of bleeding. The authors present a case of a 50-year-old man who presented with symptoms of tic douloureux caused by tentorial dAVM, which was treated successfully by SRS. Case Description: The patient consulted us with a 1-month history of harboring right trigeminal neuralgia. The cerebral angiography revealed a dAVM in the petrotentorial region and the MRI demonstrated a dilated petrosal venous varix compressing the root entry zone of the right trigeminal nerve. Gamma knife surgery was performed with a marginal dose of 18 Gy and a maximum dose of 30 Gy in a volume of 0.3 mL. The target point of the radiosurgery for this patient was a fistula identified by superselective angiography, enhanced computed tomography, and MRI. Follow-up MRI, 1 year after GKS, showed a thrombosed lesion, and the patient was able to end medication. There was no evidence of recurrence or adverse effects in the 3-year follow-up. Conclusion: Stereotactic radiosurgery can play an effective role as a treatment modality for such unusual dAVMs. [Copyright &y& Elsevier]

Background.We describe a treatment protocol for patients who have a dural arteriovenous fistulae (dAVF) not curable solely by an endovascular approach.Material and methods.Three patients suffering from neurological impairment due to a complex dAVM (intracranial haemorrhage 2, intracranial hypertension 1) were treated by a combination of arterial embolization treatment and subsequent surgery.Results.Marked reduction of flow was achieved by embolization of the main arterial feeders of the fistulae. Surgery eliminated the residual dAVFs completely and without permanent morbidity.Conclusion.It is necessary to eliminate a dural fistula completely, especially in a patient whose fistula had drainage or reflux into cortical veins, which have a high risk of intracranial haemorrhage and venous hypertension. We present an approach to treatment using transarterial embolization and early surgery which may offer a safe and effective way to achieve complete elimination of the lesion, avoiding increased risk to important venous drainage. [ABSTRACT FROM AUTHOR]

Describes the mechanism for the development of cavernous dural arteriovenous fistula that presents clinically as carotid cavernous fistula in a 58-year-old woman. Importance of neuroimaging and carotid angiography in the diagnosis of Tolosa-Hunt Syndrome; Efficacy of steroid therapy.

An unusual case of intracranial hypertension and symptoms of a left parieto-occipital mass lesion due to a dural arteriovenous malformation (AVM) with a large and dilated draining vein is reported. The patient also had a history of homolateral recurrent subdural haematoma, 11 years before. Subdural haematoma is rarely associated to a dural AVM. We suggest that the recurrent subdural haematoma was due to the very slow and intermittent venous bleeding from the preexisting dural malformation, which progressively enlarged in the following years to become very large. The symptoms of intracranial hypertension and papilloedema may be explained by the increased pressure in the dural sinus and the cerebral venous system. On the other hand, focal neurological symptoms in our case resulted from the mass effect due to an aneurysmally dilated draining vein in the left parieto-occipital region. [ABSTRACT FROM AUTHOR]

Dural Arteriovenous Malformations (DAVFs) are rare vascular malformations involving the dura and cerebral veins. They occur in a variety of locations but in general the cavernous sinus lesion is more frequent among Asian patients while the transverse sinus is more usual among western patients. Treatments include microsurgery, endovascular embolization and GKNS. The dangerous concomitant of DAVFs is retrograde flow into the cerebral veins (CVR). Patients with CVR are at risk for bleeding, neurological deficit and in some cases death. They require treatment with the aim of occluding the fistula. Patients without CVR may or may not require therapy, depending on the severity of the symptoms associated with the fistula. These patients require reduction of symptoms more than occlusion. GKNS may often be associated with embolization., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Two cases of dural arteriovenous malformation (DAVM) fed by the anterior ethmoidal artery in the anterior cranial fossa are reported, one of them examined by magnet resonance imaging (MRI). Only one other case with MRI findings so far has been published. Fourty-eight previously reported cases are reviewed. One of our patients presented with subdural haematoma (SDH) without subarachnoid or intracerebral haemorrhage. The other patient had a nasal bleed without any neurological manifestations. In comparison with previously reported cases, the clinical manifestation of our cases is infrequent (1 patient with nasal bleed, and 2 patients with pure SDH that is 2 and 4%, respectively, in the literature). Feeder was the anterior ethmoidal artery either unilateral or bilateral. Drainage of DAVMs was through a markedly dilated vascular sac into the superior sagittal sinus (SSS). The high incidence of haemorrhage from DAVM in the anterior fossa is related to this vascular sac. Magnetic resonance imaging (MRI) showed a flow void area in the left frontal region on T 1-weighted images in one case. These cases were treated by surgical excision of the malformation with good results. Aetiology, clinical presentation, and treatment of these rare DAVMs in the anterior cranial fossa is discussed. [ABSTRACT FROM AUTHOR]

The authors report a case of pituitary adenoma associated with dural arteriovenous malformation (AVM), which caused brain stem haemorrhage during transsphenoidal surgery. The manoeuvre of increasing the endexpiratory pressure in order to push the suprasellar component of the adenoma down to the sella turcica could be the reason of this bleeding. The authors therefore recommend that in cases of such a combination any manoeuvres which are likely to increase the intracranial venous pressure or otherwise affect the intracranial pressure, are avoided. The dural AVM spontaneously regressed after haemorrhage. [ABSTRACT FROM AUTHOR]

Dural arteriovenous malformation (AVM) is a rare clinical entity, presenting most commonly in adult patient with pulsatile tinnitus or haemorrhage. We report a case of a neonate with a massive dural arteriovenous malformation (AVM) with signs of cardiac failure soon after birth. The diagnosis was first suggested during angiocardiography when a hypertrophied left common carotid artery was detected. The AVM was supplied by branches from the left external carotid artery and the left veretebral artery and drained into the left transverse sinus near the torcula. This was excised in two stages. Post-operative angiography showed no residual malformation. The patient was well and developing normally 4 years after surgery. Review of the literature showed only 2 similar cases of dural AVM presenting in the neonatal period, both patients died, reflecting the high risks involved and the difficulties encountered in the management. Ligation of arterial supplies can be a useful temporary procedure in these high risk babies. Definitive excision should be performed later when the baby grows stronger. [ABSTRACT FROM AUTHOR]

Twenty-six cases with spontaneous carotid-cavernous fistulas were followed up for periods ranging between 4 months and 9 years 8 months. A complete regression of symptoms without reappearance for more than 6 months was noted in 19 cases, a marked improvement in 2 cases, and a moderate regression in 3 cases. In 2 cases, symptoms have continued for 9 years 8 months and for 1 year. The regression of symptoms was usually delayed in patients less than 60 years old, in cases in which the symptoms developed slowly, and in cases with multiple draining veins. According to our observations a regression of symptoms may occur after very slight changes of haemodynamics. Compression of the cervical carotid artery for a short time or a temporary occlusion of the carotid artery by a balloon catheter should be considered as the treatment of choice in the first instance in cases with spontaneous carotid-cavernous fistulas showing relatively low pressure and low flow shunt. [ABSTRACT FROM AUTHOR]

Dural arteriovenous fistula, (AVF), a rare entity, presents most commonly in adults. An 11-month-old boy presented with symptoms of congenital toxoplasmosis associated with an extensive dural AVF of the torcular Herophili and bilateral occulusion of the transverse and sigmoid sinuses. His intracranial venous drainage had become rerouted via the cavernous sinuses to the ophthalmic veins. The relationship of toxoplasmosis and sinus thrombosis to the pathogenesis of dural AVF and their clinical and radiological features are discussed. [ABSTRACT FROM AUTHOR]

4 patients with acquired arteriovenous shunts located in the wall of an ectatic vein of Galen (VG) are reported. They represent so-called VG dural arterio-venous malformations (DAVM). These shunts involve the vasa vasorum normally present in the VG wall. Physiopathology, clinical signs and age groups are usually the same as those encountered in other DAVMs; conversely they are totally different from the other mural shunts of the VG, detected in the pediatric population (true VG arteriovenous malformations), and leading to different clinical symptoms. Venous approach in these VG DAVMs is almost always contraindicated unless secondary occlusion of VG afferent has spontaneously excluded the pouch from the cerebral venous circulation. [ABSTRACT FROM AUTHOR]

The occurrence of post-operative dural arteriovenous malformation (AVM) has rarely been proved angiographically. The authors report two such cases: in one, a pure dural AVM was located in the region of the cavernous sinus and in another a mixed pial and dural AVM was found in the posterior fossa. The literature about pathogenesis is reviewed. [ABSTRACT FROM AUTHOR]

Two cases of dural arteriovenous malformation at the base of the anterior fossa are reported. The angiographic appearance in both cases is quite uniform and resembles the findings in 12 cases previously reported. Feeders are anterior and/or posterior ethmoidal arteries and the external carotid system also contributes. A drainage vein always shows aneurysmal dilatation of its proximal portion. CT findings are also mentioned and radiological literature reviewed. [ABSTRACT FROM AUTHOR]

The case of a patient with a fistula between the left internal carotid artery and the cavernous sinus, and another fistula between the right external carotid artery and the cavernous sinus, is reported. The clinical symptomatology, which was of spontaneous onset, was unilateral and consisted of exophthalmos and injection of the conjunctiva on the left side. Almost complete remission occurred after angiography. [ABSTRACT FROM AUTHOR]

Transvenous embolization is the favored treatment for indirect carotid-cavernous fistulas (CCFs). However, transarterial embolization can be used as an alternative method when the venous route is inaccessible. We present the case of a 47-yr-old woman with a history of diplopia, headaches, and sixth cranial nerve (CN-VI) palsy who presented with acute worsening of headache and ophthalmoplegia and rise of intraocular pressures. Angiography demonstrated a left indirect CCF (dural arteriovenous malformation) with multiple arterial feeders from the internal carotid artery as well as the middle meningeal artery (MMA) (Barrow type D). Transvenous approach was attempted first but was unsuccessful due to difficult access to the cavernous sinus. Thus, transarterial embolization through the MMA feeding branches was planned. To avoid occluding distal branches of the MMA by Onyx, we coiled it distally. In addition, we used a scepter balloon proximally to prevent the reflux of Onyx into potential collaterals to cranial nerves from proximal MMA. After trapping a segment of the MMA, Onyx was injected into the CCF fistula through the small MMA feeders. A postembolization arteriogram showed obliteration of the CCF. The patient developed mild left facial nerve paresis on the first postoperative day (thought to be related to partial embolization of tiny arteries in the facial canal), which was resolving in the course of hospitalization. She remained neurologically stable, and was discharged on the third postoperative day. To the best of our knowledge, this is the first report of transarterial embolization of CCF by distal coiling and proximal ballooning to trap a segment of an artery. The authors hereby confirm that informed consent was obtained from the patient after thorough discussion of the procedure's rationale, risks, benefits, and alternatives., (© Congress of Neurological Surgeons 2021.)

Dural arteriovenous fistulas (DAVFs) are complex vascular abnormalities that account for 10-15% of intracranial vascular malformations. DAVFs are typically encountered in middle-aged adults, with a slightly female predominance. The causative factors are still uncertain; however, abnormal local hemodynamics and neoangiogenesis related to dural sinus or venous thrombosis can contribute to DAVF occurrence. The diagnosis is dependent on a high level of clinical suspicion and high-resolution imaging techniques. Computed tomography and/or magnetic resonance imaging aid in the diagnosis, but conventional angiography remains the most accurate method for the complete characterization and classification of DAVFs. The therapeutic approach can be conservative or more aggressive, based on symptom severity, sequelae risk and patient characteristics. This article is a pictorial review of adult intracranial DAVFs that highlights some tips and tricks for recognizing useful red flags in the suspicion of DAVFs., (Copyright © 2019. Published by Elsevier Masson SAS.)

Dural arteriovenous malformations (AVMs) in the posterior cranial fossa are relatively infrequent. Intradural haemorrhage is one of their specific complications. Angiographic demonstration of varices or aneurysmal structures is one of the hallmarks of severe cases. We report a patient with posterior cranial fossa dural AVM associated with a varix mimicking a thrombosed aneurysm on CT and MRI. Internal carotid and vertebral angiography failed to demonstrate an aneurysm, but external carotid injection revealed a dural AVM affecting the sigmoid sinus, and a varix. The AVM was completely eliminated by embolization. When a dural AVM is suspected clinically selctive angiography should be performed to confirm the diagnosis even when CT or MRI do not show dilated vessels. [ABSTRACT FROM AUTHOR]

Intracranial arteriovenous malformations (AVM) are rare lesions that are often discovered fortuitously. They should be identified on CT scan and MRI before resorting to angiography; the latter is used to prepare the treatment. This article describes the various types of subpial or dural AVM and the specific characteristics that enable their differentiation with non-invasive imaging. The factors that determine the severity of these lesions, whether discovered before or after a haemorrhage, are described, as well as prognostic indicators., (Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)