Successful treatment of a case of tentorial dural arteriovenous fistula causing subarachnoid hemorrhage with invagination of the brainstem by huge and multiple venous pouches.
Combined treatment with endovascular and direct surgery
multiple venous pouches
subarachnoid hemorrhage
tentorial dural arteriovenous fistula
Journal
Surgical neurology international
ISSN: 2229-5097
Titre abrégé: Surg Neurol Int
Pays: United States
ID NLM: 101535836
Informations de publication
Date de publication:
2019
2019
Historique:
received:
11
09
2018
accepted:
13
11
2018
entrez:
19
2
2019
pubmed:
19
2
2019
medline:
19
2
2019
Statut:
epublish
Résumé
We present a case of tentorial dural arteriovenous fistula (TDAVF) causing subarachnoid hemorrhage with mass effect of large venous pouches, which was struggling to diagnosis and management due to complex vasculature and severe general condition. A 43-year-old man was transferred to our hospital due to sudden consciousness disturbance. A neurological examination revealed tetraparesis and pupil dilatation with no light reflex. Imaging findings showed a large lesion in the brainstem with subarachnoid and intraventricular hemorrhage. Since there were multiple feeding arteries and large and multiple venous pouches on vascular imaging, we diagnosed the patient with TDAVF. Because of a high-flow arteriovenous shunt and the presence of large venous pouches, it appeared to be very difficult to approach the shunting point by direct surgery. Therefore, we first performed transarterial endovascular treatment with 25% This combined maneuver with endovascular embolism as complementary pretreatment for radical surgery is useful for a case with high-flow shunting and large venous pouches.
Sections du résumé
BACKGROUND
BACKGROUND
We present a case of tentorial dural arteriovenous fistula (TDAVF) causing subarachnoid hemorrhage with mass effect of large venous pouches, which was struggling to diagnosis and management due to complex vasculature and severe general condition.
CASE DESCRIPTION
METHODS
A 43-year-old man was transferred to our hospital due to sudden consciousness disturbance. A neurological examination revealed tetraparesis and pupil dilatation with no light reflex. Imaging findings showed a large lesion in the brainstem with subarachnoid and intraventricular hemorrhage. Since there were multiple feeding arteries and large and multiple venous pouches on vascular imaging, we diagnosed the patient with TDAVF. Because of a high-flow arteriovenous shunt and the presence of large venous pouches, it appeared to be very difficult to approach the shunting point by direct surgery. Therefore, we first performed transarterial endovascular treatment with 25%
CONCLUSIONS
CONCLUSIONS
This combined maneuver with endovascular embolism as complementary pretreatment for radical surgery is useful for a case with high-flow shunting and large venous pouches.
Identifiants
pubmed: 30775056
doi: 10.4103/sni.sni_317_18
pii: SNI-10-2
pmc: PMC6357536
doi:
Types de publication
Case Reports
Langues
eng
Pagination
2Déclaration de conflit d'intérêts
There are no conflicts of interest.
Références
Surg Neurol. 2006 May;65(5):511-5
pubmed: 16630920
Stroke. 2008 Jun;39(6):1735-9
pubmed: 18388337
Neurosurgery. 2008 Mar;62(3 Suppl 1):110-24; discussion 124-5
pubmed: 18424975
Proc (Bayl Univ Med Cent). 2008 Jul;21(3):255-7
pubmed: 18628973
World Neurosurg. 2010 Apr;73(4):365-79
pubmed: 20849795
J Neurosurg. 1990 Jun;72(6):839-50
pubmed: 2140125
J Neuroradiol. 1990;17(3):161-81
pubmed: 2286839
Neurol Med Chir (Tokyo). 2014;54(1):63-71
pubmed: 24390192
AJNR Am J Neuroradiol. 1989 Mar-Apr;10(2):393-9
pubmed: 2494859
J Neurosurg. 2017 Jun;126(6):1884-1893
pubmed: 27588586
Radiology. 1969 Nov;93(5):1071-8
pubmed: 5350675
J Neurosurg. 1995 Feb;82(2):166-79
pubmed: 7815143
Radiology. 1995 Mar;194(3):671-80
pubmed: 7862961
J Neurosurg. 1994 Dec;81(6):851-9
pubmed: 7965115
AJNR Am J Neuroradiol. 1998 Jun-Jul;19(6):1081-7
pubmed: 9672015