De Novo Multiple Dural Arteriovenous Fistulae Successfully Treated with Transarterial Embolization Using Low-concentration N-butyl-2-cyanoacrylate: A Case Report

• Published in: Journal of Neuroendovascular Therapy 2018, Vol.12(11), pp.560-566
• Main Authors: Izawa, Daisuke, Masuo, Osamu, Kawaguchi, Takumi, Yako, Rie, Nakao, Naoyuki
• Format: Article
• Language: English
• Subjects: de novo dural arteriovenous fistula; low-concentration n-butyl-2-cyanoacrylate; multiple shunts; transcatheter arterial embolization
• ISSN: 1882-4072; 2186-2494
• DOI: 10.5797/jnet.cr.2017-0132

Objective: We describe a case of de novo dural arteriovenous fistula (dAVF) developed after bilateral neck clipping for middle cerebral artery (MCA) aneurysms, treated with transarterial embolization (TAE) using liquid materials.Case Presentation: A 60-year-old man underwent neck clipping for a right ruptured MCA aneurysm, and a left unruptured MCA aneurysm. Follow-up MRA 1 year after the clipping showed an abnormal enlarged bilateral occipital artery (OA). Onyx was partially penetrated to parasinus, but low-concentration n-butyl-2-cyanoacrylate (NBCA) was widely penetrated to parasinus. After that, developed memory disturbance gradually worsened. The angiography demonstrated dAVF at transverse sinus, sigmoid sinus (SS), sinus confluence, and superior sagittal sinus with numerous cortical venous reflux. He was treated with TAE with liquid in two sessions. After embolization, cortical venous reflux completely disappeared and his cognitive dysfunction could be rapidly resolved. One year after the treatment, the angiogram revealed no recurrence of cortical venous reflux and he could maintain his independence.Conclusion: In this case, bilateral craniotomy for neck clipping caused “de novo” dAVF presenting with cognitive dysfunction. In addition, TAE using NBCA was very useful to cure multiple dAVF.