Magnetic resonance spectroscopy findings in patients with dural arteriovenous fistulas: Three case reports

• Published in: World neurosurgery 2017-08, Vol.104, p.1050.e7-1050.e11
• Main Authors: Nagashima, Hiroaki, M.D. Ph. D, Fujita, Atsushi, M.D. Ph. D, Tanaka, Jun, M.D, Kohta, Masaaki, M.D. Ph. D, Sasayama, Takashi, M.D. Ph. D, Tanaka, Kazuhiro, M.D. Ph. D, Hosoda, Kohkichi, M.D. Ph. D, Kohmura, Eiji, Prof,. M.D. Ph. D
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aspartic Acid - analogs & derivatives; Aspartic Acid - metabolism; Central Nervous System Vascular Malformations - complications; Central Nervous System Vascular Malformations - diagnostic imaging; Central Nervous System Vascular Malformations - metabolism; Central Nervous System Vascular Malformations - surgery; Cerebral Angiography; Creatine - metabolism; Dural arteriovenous fistula; Headache - etiology; Humans; Inositol - metabolism; Lactate; Lactic Acid - metabolism; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Metabolism; Middle Aged; Myo-inositol; N-acetylaspartate; Neurosurgery; Neurosurgical Procedures; Seizures - etiology; Transverse Sinuses - diagnostic imaging; Transverse Sinuses - metabolism; Transverse Sinuses - surgery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.05.113

Abstract Background Magnetic resonance spectroscopy (MRS) is a potentially useful modality for evaluating brain metabolites in patients with dural arteriovenous fistula (dAVF). Here, we propose a different pattern of MRS-based cerebral metabolism findings in patients with dAVF. Case Description We performed MRS in three patients with transverse sigmoid sinus dAVF associated with cortical venous reflux. In case 1, which was associated with vasogenic edema on T2-weighted imaging, decreasing preoperative N-acetylaspartate/creatine, myo-inositol/creatine and increasing lactate/creatine ratios improved after treatment. In case 2, decreasing preoperative N-acetylaspartate/creatine ratios improved after treatment. These two patients presented with seizure. In case 3, the patient presented with headache and showed no metabolic changes on preoperative or postoperative MRS. Conclusion Our results suggest that patients with dAVF could be classified based on a combination of metabolic and signal changes seen on T2-weighted imaging. MRS may allow significantly expanded evaluation of the metabolic changes associated with dAVF for appropriate classification and management.